护理人员职业能力倾向测评体系的研究

目的 构建一套系统、科学的护理人员职业能力倾向测评体系,为进一步编制相应的测评工具奠定基础。方法 采用Delphi法对30名专家进行了两轮函询,对指标进行筛选与修正。结果 两轮问卷有效回收率均为100%,表明专家对本研究的积极性较高;专家对评价指标的权威系数在0.8以上,结果具有较高的权威性。构建了包括二级结构的指标体系,其中一级指标3项,二级指标10项。结论 初步构建了护理人员职业能力倾向测评体系。

     

国家综合性医疗中心评价指标筛选研究

目的 探索建立国家综合性医疗中心评价指标框架，为我国国家区域医疗中心的建设和评价工作提供参考。方法 综合运用文献分析法、专题小组讨论法和专家咨询法，对国家综合性医疗中心评价指标进行了筛选研究。结果 确定了包括6个一级指标、22个二级指标、94个三级指标在内的国家综合性医疗中心评价指标框架。结论 评价指标的专家积极系数和权威系数较高，但二级和三级指标的协调系数偏低，需要经过多轮专家咨询后进一步提高专家意见的一致性。     

基于德尔菲法的广东省医师多点执业实施框架构建

目的 构建符合广东省医疗卫生现状和特点的医师多点执业实施基本框架。方法 采用Delphi法对备选指标进行3轮专家咨询。结果 预调查和2轮咨询专家积极性系数分别为100%、96.67%、100%;专家的权威系数为0.70;正式两轮咨询一级指标权重权重比例接近,P＜0.005 ;正式两轮咨询专家一致性系数分别为0.161、0.191。结合专家对指标评价总分的排序和各指标重要性、可操作性变异系数,最终筛选25个指标。结论 从公立医院的角度,构建了一个较为科学、合理的医师多点执业实施框架。     

医学院校附属医院护理人员科研能力影响因素分析

目的 分析筛选医学院校附属医院护理人员科研现状及影响因素,为提高护理人员的科研能力提供依据。方法 选取38位资深专家采用德尔菲法确定科研能力评价指标。采用随机抽样的方法对某医学院校4所附属医院200名护理人员进行问卷调查,采用多因素Logistic回归法分析护理人员科研能力影响因素。结果 分析表明,学历、团队情况、科研经费、科研管理规范性4个因素对护理人员的科研绩效影响作用显著。结论 为进一步提高医学院校附属医院护理人员的科研能力,应该加强护理人员学历教育、培养护理科研团队、增加护理科研经费的投入以及加强护理科研管理的规范性。

     

基于工作职责模糊聚类分析的护理人员等级划分研究

目的 对我国临床护理人员的工作职责进行分类研究,为护理人员等级划分提供依据。 方法 30名护理专家从学历、工作时间、知识和技能、能力4个方面对筛选出的32项护理人员工作职责进行评分,对评分结果进行模糊聚类分析。 结果 当λ=0.993 3时,护理人员工作职责聚为6类,此时模糊聚类结果与实际情况最相符合。 结论 根据聚类结果和实际情况,我国临床护理人员可划分为5个等级,每个等级护理人员的学历、工作时间、知识和技能、能力与其所承担的职责相匹配。     

马尾松PmPGK1和PmGPIC基因的克隆和表达分析

为了解马尾松（Pinus massoniana）磷酸甘油酸激酶1（PGK1）与胞质溶胶葡萄糖磷酸异构酶（GPIC）的功能，采用RACE技术克隆了PmPGK1和PmGPIC基因，并进行了生物信息学分析与亚细胞定位，采用实时荧光定量PCR技术分析PmPGK1和PmGPIC的表达特性。结果表明，PmPGK1和PmGPIC全长为2 106和1 848 bp，分别编码507和566个氨基酸。PmPGK1和PmGPIC分别定位于叶绿体和胞质溶胶。PmPGK1表达量为新叶 > 老叶 > 新茎 > 根 > 花；而PmGPIC为老叶 > 花 > 新叶 > 新茎 > 根。低温胁迫24 h，PmPGK1和PmGPIC的表达量均随时间延长先降低后升高，且PmGPIC的表达量在处理2 h后即降至较低水平；高浓度CO₂胁迫24 h，PmPGK1的表达量随时间延长呈降低-升高-再降低的变化趋势，PmGPIC的表达下调但变化较不显著。因此，推测PmPGK1主要参与卡尔文循环及叶绿体/质体糖酵解，PmGPIC主要参与细胞质基质糖酵解；PmPGK1、PmGPIC活性在低温胁迫下均受抑制；PmPGK1活性在CO₂胁迫下受到显著抑制，而PmGPIC活性的影响不大。     

医院管理培训效果评估指标体系研究

目的 构建科学、实用的医院管理培训效果评估指标体系。方法 通过预调查和专家访谈设计指标体系,运用Delphi法进行指标的筛选,层次分析法用于指标权重的确定。结果 构建的培训效果评估指标体系包括反应层、学习层、行为层和结果层4个层面的11项一级指标和54项二级指标,确定了各级指标的权重,指标权重判断矩阵排序一致性比率均小于0.100;2轮调查问卷的有效回收率均高于90%,专家的权威系数均在0.8以上,指标变异系数为0.08～0.22之间,协调系数经检验呈显著性(P<0.001)。结论 构建的医院管理培训效果评估指标体系层次分明,指标数量适中,权重合理稳定,具备良好的可操作性。     

基于患者体验的医疗服务质量关键指标体系构建

??????? 目的 初步构建基于“患者体验”的医疗服务质量关键指标体系。方法 通过检索国内外相关文献,构建指标体系框架和专家咨询表并进行2轮专家咨询,确定了基于“患者体验”的医疗服务质量关键指标体系。结果 构建基于“患者体验”的医疗服务质量关键指标体系,一级指标有有形性、可靠性、反应性、保证性、关怀性和连续性6个,二级指标28个,三级指标83个。结论 基于患者体验的医疗服务质量关键指标体系具有很强的实用性,为患者体验量表开发奠定基础。研究结果对于改进我国医疗服务质量评价手段和策略具有重要意义。     

铁皮石斛体细胞胚胎发生类受体激酶基因DoSERK的克隆和表达分析

为了解铁皮石斛(Dendrobium officinale)中的体细胞胚胎发生类受体激酶基因DoSERK 的功能,在转录组测序数据的基础上克隆了DoSERK 的全长cDNA。结果表明,DoSERK 与其他植物的SERK 高度同源,编码633 个氨基酸。生物信息学分析表明,DoSERK蛋白为亲水蛋白并定位于质膜,具有1 个信号肽、1 个富脯氨酸区域、1 个跨膜区、5 个富亮氨酸重复序列以及1 个保守的蛋白激酶活性结构域,属于SERK 蛋白家族成员。系统进化树分析表明,DoSERK 与同为兰科植物的文心兰(Cyrtochilum loxense)以及卡特兰(Cattleya maxima)的SERK 亲缘关系最近。组织表达分析表明,DoSERK 在铁皮石斛中广泛表达,以幼嫩小苗根部的表达量最高。这些说明DoSERK 除了可能参与铁皮石斛体胚发生过程以外,还参与其他生长发育过程。     

基于Tail-PCR分析AN2基因上游启动子活性

黑果枸杞(Lycium ruthenicum)富含花青素,AN2基因是调控黑果枸杞花青素合成代谢的主效基因。为解析AN2基因启动子的活性差异,采用Tail-PCR方法分别克隆了黑果枸杞和红果枸杞(L. barbarum) AN2基因起始密码子上游约1 686 bp (LrAN2p)和1 495 bp (LbAN2p)的序列。Plant CARE预测表明,LbAN2p和LrAN2p中分别有133和137个的顺式作用元件, 其中,参与光调控的顺式元件分别有11和15个;参与激素响应相关的顺式元件分别有13和16个。构建AN2启动子植物表达载体pKGWFS7:LbAN2p和pKGWFS7:LrAN2p,利用农杆菌介导的烟草遗传转化体系获得转基因烟草。GUS染色结果表明,LrAN2p能够驱动GUS在烟草中的表达,叶片呈现蓝色,具有较LbAN2p更强的启动活性,qRT-PCR结果表明,LrAN2p转基因烟草中GUS基因具有更高的转录水平,这可能会使AN2基因在黑果枸杞中具有更高的表达,激活黑果枸杞花青素合成代谢通路。这为解析枸杞果色形成及AN2基因的表达调控机制奠定了理论基础。     

Ectogenesis and the case against the right to the death of the foetus

Ectogenesis, or the use of an artificial womb to allow a foetus to develop, will likely become a reality within a few decades, and could significantly affect the abortion debate. We first examine the implications for Judith Jarvis Thomson’s violinist analogy, which argues for a woman’s right to withdraw life support from the foetus and so terminate her pregnancy, even if the foetus is granted full moral status. We show that on Thomson’s reasoning, there is no right to the death of the foetus, and abortion is not permissible if ectogenesis is available, provided it is safe and inexpensive. This raises the question of whether there are persuasive reasons for the right to the death of the foetus that could be exercised in the context of ectogenesis. Eric Mathison and Jeremy Davis have examined several arguments for this right, doubting that it exists, while Joona Räsänen has recently criticized their reasoning. We respond to Räsänen’s analysis, concluding that his arguments are unsuccessful, and that there is no right to the death of the foetus in these circumstances.     

On the diversity of the Cladocera in the tropics

The mythical concept of an impoverished tropical cladoceran fauna is refuted. On a planetary scale, around half of the cladoceran species presently known occur exclusively in the tropics-subtropics, often with considerable restriction to particular geographical subzones. On a regional (political) scale, the situation is often unclear because of the continued fragmentary nature of studies, and because political units are not a good basis for biogeographical comparisons. At the finest level of resolution (lake-perlake comparisons), there appears to be an upper limit of c. 50 cladoceran species per individual lake. No significant difference between lakes in the temperate zone and in the tropics could be established here. Daphnia is largely absent from the tropics, but is replaced by more Sidids, Moinids, and Bosminids, such that the average cladoceran community in the limnetic zone of a tropical lake is not characterized by less species but rather by lower population densities. This, in turn, is considered a consequence of higher prevalent predation levels in the tropics.     

Tubular networks in the terminal endings of the visual receptor cells in the human,the monkey,the cat and the dog

Summary A tubular network was found in the terminal endings of the visual receptor cells in the human, the monkey (Macaca mulatta), the cat and the dog. These tubules are arranged in close groups in the vicinity of the synaptic lamellae and the invaginated dendrites. According to the form, diameter, density of the tubules and to the consistence of the network formed by them one can distinguish at these places an initial type (type I), a transitory (type II) and a vesicular one (type III). In the the type III branching, bizarre forms are frequent. The diameter of all the tubules reaches 500–600 Å, their density and walls being the same as in the synaptic vesicles.Similar networks also occur in the axons of the visual receptor cells of the monkey.

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Zusammenfassung In den Endigungen der Photorezeptorzellen von Mensch, Affe (Macaca mulatta), Katze und Hund kommen aus Tubuli bestehende Komplexe vor. Organellenartig in geschlossenen Gruppen angeordnet, liegen sie in Nähe der synaptischen Lamellen und der invaginierten Dendriten. An diesen Stellen kann man nach Form, Durchmesser, Dichte und Konsistenz der von den Tubuli gebildeten Komplexe drei Typen unterscheiden: 1. einen initialen (Typus I), 2. einen Übergangstypus (Typus II) und 3. einen vesiculären Typus (Typus III). In letzterem kommen häufig verzweigte, bizarre Formen vor. Der Durchmesser sämtlicher Tubuli erreicht 500–600 Å. Ihre Dichte und ihre Wand gleicht denen der synaptischen Vesikel.Ähnliche Komplexe fanden wir auch in den Axonen der Photorezeptorzellen vom Affen.

     

Assessing the Physiological State of the Fucoids from the Barents Sea Littoral by the End of the Polar Night

Methods of amperometry and potentiometric titration were used to follow dark respiration (DR) and apparent photosynthesis (AP) in the fucoids Ascophyllum nodosum (L.) Le Jol, Fucus vesiculosus L., and F. serratus L. from the Barents Sea littoral by the end of the 40-day-long polar night. The macroalgae were shown to manifest species-specific low rates of photosynthesis and respiration. However, in spite of their low photosynthetic status due to the effects of subzero temperature and prolonged low or zero illumination, the macroalgae have been able to restore DR and AP to the initial level already by the day 9; the ability to restore AP depended on the level of illumination. The study of the changes in the carbonate–bicarbonate system in the light and darkness demonstrated that the macroalgae grown in darkness, in contrast to those grown in twilight, could absorb bicarbonate in darkness; however, they lost this capacity after two-day-long illumination at an irradiance of 7 mol/(m² s). Bicarbonate uptake in darkness and the capacity to restore the systems of photosynthesis and respiration in fucoid cells are discussed in the context of algal energy metabolism under the polar night conditions.     

Arranging the elements of the potassium channel: the T1 domain occludes the cytoplasmic face of the channel

The voltage-gated potassium channel is currently one of the few membrane proteins where functional roles have been mapped onto specific segments of sequence. Although high-resolution structures of the transmembrane portions of three bacterial potassium channels, the tetramerization domain and the cytoplasmic ball are available, their relative spatial arrangement in mammalian channels remains a matter of ongoing debate. Cryo-electron microscopic images of the six transmembrane voltage-gated Kv channel have been reconstructed at up to 18 Å resolution, revealing that the T1 domain tetramerizes and is suspended below the transmembrane segments. However, the resolution of these images is insufficient to reveal the location of the third piece of the puzzle, the inactivating ball domain. We have used the aberrant interactions observed in a series of chimæric channels to establish that an assembled T1 domain restricts access to the cytoplasmic face of the channel, suggesting that the N-terminal ball and chain may be confined in the space between the T1 domain and the transmembrane portion of the channel.     

Feeding the vertebrate retina from the Cambrian to the Tertiary

The retina of the vertebrate eye is metabolically active and requires nutritive support. During the last 540 million years it has evolved into forms as complicated and nutritionally demanding as those found in avian or primate eyes. Diffusion from the choroid is generally able to supply the metabolic needs of thin retinae. However, when the thickness exceeds the limits of diffusion, structures are needed to supplement the vascular supply from the choroid. These supplemental nutritive devices include the choroidal gland, the falciform process and preretinal vascular plexus of fish, the conus papillaris of lizards, the pecten oculi of birds, the intraretinal vessels of mammals and a few novel systems that remain difficult to classify. These vascular systems are among the most variable features of the vertebrate eye. Here, we review classical and recent findings regarding such retinal nutrition systems, propose a three category classification for them based on histologic origins and speculate on the evolutionary forces which drove their development.     

Observations on the permeability of the choriocapillaris of the eye

Summary The choriocapillaris is a fenestrated capillary bed located posterior to the retinal pigment epithelium. It serves as the main source of supply to the photoreceptors, retinal pigment epithelium, and other cells of the outer retina. The permeability of these capillaries to intravenously injected ferritin (MW — approx. 480,000; mol. diam. 11 nm) was examined in the mouse, rabbit, and guinea pig, each of which is characterized by a different type of retinal vascularization. In all three species, the bulk of the ferritin remained in the capillary lumina, where it appeared to be blocked at the level of the diaphragmed fenestrae. Some ferritin was present in endothelial cell vacuoles. The results confirm previous work on the rat choriocapillaris and indicate that the barrier function of the choriocapillary endothelium is present even among species in which the retinal circulation differs significantly.Supported by NIH grant EY03418