医师多点执业实施困境的多级递阶结构模型构建研究

目的 构建我国医师多点执业制度实施困境的多级递阶结构模型,阐释各阶层间的内在逻辑,旨在为完善医师多点执业制度提供建设性策略。方法 采用文献法辅助4位卫生政策与管理专家核检,总结并归纳当前我国医师多点执业制度实施进程中的制约因素。采用解释结构模型方法解构各影响因素间的层级关系及传导环路。结果 我国医师多点执业制度实施困境的12类制约因素存在一个“四阶梯结构”与“一条传导环路”。直接因素为“医生积极性不足”及“个人利益受损威胁”,深层要素是“宏观政策的调控力不足”,通过“政策—制度—组织—个体”逐级递阶掣肘我国医师多点执业制度实施进程。结论 我国医师多点执业制度必须根植于“政策与立法”的双向保障,依赖于“制度与组织”的全面建设,才能实现“组织与个体”的协同共赢。     

湖北区域医疗联合体的实践与思考

湖北省在医改试点中探索了6种区域医疗联合体实践模式,针对区域医疗联合体实践中存在的困难和问题进行了深入的剖析,提出了相应的思考与建议,以期为正在进行的公立医院改革试点提供参考性意见。     

我国医疗联合体发展的动态分析

目的 对我国医疗联合体各阶段发展进行动态分析。方法 运用文献荟萃分析的方法,针对医疗联合体产生发展的各时期特征进行阶段划分。结果 我国医疗联合体自产生时起可分为3个发展时期,分别为1980—1989年萌芽期,医联体萌芽产生;1990—2009年形成期,医联体缓慢发展、典型类型形成;2010年至今发展期,医联体快速发展。结论 随着医改的深化,我国医疗联合体将不断改革发展,概念不断完善、类别更为丰富、紧密程度更受重视。

     

九江市区域医疗联合体建设的实践与思考

介绍了九江市区域医疗联合体建设的基本情况、联合模式、主要做法以及主要成效,分析了医疗联合体运行过程中存在的一些共性问题。可借鉴国内医疗联合体建设的成功经验,进一步完善运作模式,推动医疗联合体健康发展。     

植物的芳香性与分泌结构

介绍了植物体内芳香性物质的种类、产生芳香性物质的解剖结构及影响芳香物质产生的因素。     

ROCCIPI框架下区域医疗联合体的问题识别与分析

我国割裂的医疗服务体系和碎片化服务已经严重阻碍了医改成效,区域医疗联合体孕育而生并成为弥合割裂的战略选择。但医疗联合体并非“一联就灵”,也面临着一些困难和问题。文章以ROCCIPI技术为分析框架,系统全面地识别区域医疗联合体发展中存在的问题,并提出改进策略,为区域医疗联合体实践提供参考。     

新时期下中等规模公立医院的发展思考与建议

随着新的医改政策出台及互联网信息经济的兴起,中等规模的二级医院面临新的挑战。为了适应新常态,中等规模的公立医院应根据自身情况,在市场上寻找新的定位及发展方向,以变被动为主动。充分挖掘院内外各种资源,建立合适自身实际的医联体,做强特色专科,充分利用信息网络化系统,加快人事制度改革等均可成为中等规模公立医院改革发展的方向。

     

三级甲等公立医院过度医疗形成影响因素研究

目的 分析医方以及患方对过度医疗形成的影响因素,探讨过度医疗的形成机理。方法 随机抽调某省5所三级甲等医院进行问卷调查。运用结构方程模型,通过软件SPSS19.0和AMOS17.0进行数据分析处理。结果 医患之间的信息不对称以及医务人员自身薪酬待遇不足等因素对过度医疗的形成产生重要影响。结论 提高医务人员的薪酬待遇和消除医患之间的信息不对称是解决过度医疗问题的关键。     

影响人肠道微生物菌群结构的因素

肠道微生物与人类健康状况直接相关。目前,微生物研究者已对影响人及模式动物(主要为鼠和猪)肠道微生物菌群结构的因素展开了广泛研究,取得了较大研究进展。本文综述了影响肠道微生物菌群结构的因素,主要有年龄、宿主基因型、宿主所处环境、食物和抗生素等,以使人们了解和控制这些因素,从而保持良好的健康状态。     

基于结构方程模型的用药安全影响因素研究

目的 通过分析用药安全的影响因素和发生机制,从而提高用药安全性,预防用药差错的发生。方法 随机抽取三级、二级医院各6家,分析2010—2016年12家医院的423例用药差错事件发生的原因,同时结合个人访谈的研究方式,访谈用药差错事件发生的相关医护人员及用药安全管理部门领导共计126人,最终通过访谈及文献研究的方法确定了26个用药安全的影响因素。通过运用因子分析结合结构方程模型的方式,分析各个影响因素之间的相互作用及对用药安全的影响程度。结果 通过结构方程模型分析可知：药品因素、员工素质、患者因素、社会因素、医院管理都是高度影响用药安全的主要因素。结论 通过对关键指标的管理,提出科学、有效的防范措施。     

北京市区域医疗联合体系建设问题探究

为解决城乡和区域间医疗资源配置不均衡、不合理,基层医疗机构服务能力薄弱等问题,北京市2013年开展了区域医疗联合体系建设工作,虽然取得了一定的成绩,但从实践情况看来,政策实施的效果与预期还存在一定差距。以北京市区域医疗联合体系为研究对象,通过理论、实例相结合的方式,分析其在运行过程中出现的问题及造成这些问题的原因,为北京市区域医疗联合体系更好地发挥作用提供政策建议。     

Integrated Structural Modeling of Full-Length LRH-1 Reveals Inter-domain Interactions Contribute to Receptor Structure and Function

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Structural Equation Modeling for Observational Studies

Abstract Structural equation modeling (SEM) represents a framework for developing and evaluating complex hypotheses about systems. This method of data analysis differs from conventional univariate and multivariate approaches familiar to most biologists in several ways. First, SEMs are multiequational and capable of representing a wide array of complex hypotheses about how system components interrelate. Second, models are typically developed based on theoretical knowledge and designed to represent competing hypotheses about the processes responsible for data structure. Third, SEM is conceptually based on the analysis of covariance relations. Most commonly, solutions are obtained using maximum-likelihood solution procedures, although a variety of solution procedures are used, including Bayesian estimation. Numerous extensions give SEM a very high degree of flexibility in dealing with nonnormal data, categorical responses, latent variables, hierarchical structure, multigroup comparisons, nonlinearities, and other complicating factors. Structural equation modeling allows researchers to address a variety of questions about systems, such as how different processes work in concert, how the influences of perturbations cascade through systems, and about the relative importance of different influences. I present 2 example applications of SEM, one involving interactions among lynx (Lynx pardinus), mongooses (Herpestes ichneumon), and rabbits (Oryctolagus cuniculus), and the second involving anuran species richness. Many wildlife ecologists may find SEM useful for understanding how populations function within their environments. Along with the capability of the methodology comes a need for care in the proper application of SEM.     

Bayesian Weighing of Electron Cryo-Microscopy Data for Integrative Structural Modeling

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中国城市化速度区域差异及其主要影响因素分析

在分析2000—2014年全国地级及以上城市的人口城市化速度和建成区面积城市化速度的基础上, 评价了城市化发展与城市规模、资源、环境、经济、社会等相关指标的关系, 明确了影响中国城市化速度区域差异的关键因子。结果表明: ①人口平均年增长率的范围在-2.18%—6.74%之间, 均值为1.06%;建成区面积平均年增长率的范围在0%—15.00%之间, 均值为5.35%。建成区面积城市化速度总体上远高于人口城市化速度, 不利于集约型和节约型社会建设。②西北地区和华北地区的人口城市化速度较快, 主要受到资源因素尤其是水资源的影响;华东、西南和中南地区的建成区面积城市化速度较快, 主要受到地理因子的影响, 具有地理区位优势地区(东南沿海)的城市化速度较快。但长此以往, 将会造成东南地区的资源(尤其是土地资源)紧张及环境污染的加重, 不利于城市的可持续发展。因此, 在城市化发展的过程中, 应该遵循集约、紧凑的发展理念, 不仅要考虑每个区域的资源环境承载力, 也要提高资源开发利用和输送调配的效率, 减小对资源的浪费和生态环境的破坏。     

A Structural Model of the Urease Activation Complex Derived from Ion Mobility-Mass Spectrometry and Integrative Modeling

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区域医疗卫生服务体系评价的重要性及建议

区域医疗卫生服务体系评价对指导区域医疗资源规划,提高国家宏观调控和监管能力,实现医疗资源优化配置有重要意义。我国目前尚未建立一套科学全面的评价方法和指标体系。通过介绍区域医疗服务体系评价的重要性和影响因素,以及美国在评价区域医疗服务体系的做法,为建立完善我国区域卫生服务体系评价制度提供建议。     

Structural Architecture of the Nucleosome Remodeler ISWI Determined from Cross-Linking,Mass Spectrometry,SAXS, and Modeling

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Dynamic Modeling of Herpes Simplex Virus Type-2 (HSV-2) Transmission: Issues in Structural Uncertainty

The sexually transmitted infection (STI) Herpes simplex virus type-2 (HSV-2) is of public health concern because it is a very common frequently unrecognized lifelong infection, which may facilitate HIV transmission. Within HIV/STI modeling, structural uncertainty has received less attention than parametric uncertainty. By merging the compartments of a “complex” model, a “simple” HSV-2 model is developed. Sexual interactions between female sex workers (FSWs) and clients are modeled using data from India. Latin Hypercube Sampling selects from parameter distributions and both models are run for each of the 10,000 parameter sets generated. Outputs are compared (except for 2,450 unrealistic simulations). The simple model is a good approximation to the complex model once the HSV-2 epidemic has reached 60% of the equilibrium prevalence (95% of the 7,550 runs produced <10% relative error). The simple model is a reduced version of the complex model that retains details implicitly. For late-stage epidemics, the simple model gives similar prevalence trends to the complex model. As HSV-2 epidemics in many populations are advanced, the simple model is accurate in most instances, although the complex model may be preferable for early epidemics. The analysis highlights the issue of structural uncertainty and the value of reducing complexity.     

Structural basis for the enantiospecificities of R- and S-specific phenoxypropionate/alpha-ketoglutarate dioxygenases

(R)- and (S)-dichlorprop/alpha-ketoglutarate dioxygenases (RdpA and SdpA) catalyze the oxidative cleavage of 2-(2,4-dichlorophenoxy)propanoic acid (dichlorprop) and 2-(4-chloro-2-methyl-phenoxy)propanoic acid (mecoprop) to form pyruvate plus the corresponding phenol concurrent with the conversion of alpha-ketoglutarate (alphaKG) to succinate plus CO2. RdpA and SdpA are strictly enantiospecific, converting only the (R) or the (S) enantiomer, respectively. Homology models were generated for both enzymes on the basis of the structure of the related enzyme TauD (PDB code 1OS7). Docking was used to predict the orientation of the appropriate mecoprop enantiomer in each protein, and the predictions were tested by characterizing the activities of site-directed variants of the enzymes. Mutant proteins that changed at residues predicted to interact with (R)- or (S)-mecoprop exhibited significantly reduced activity, often accompanied by increased Km values, consistent with roles for these residues in substrate binding. Four of the designed SdpA variants were (slightly) active with (R)-mecoprop. The results of the kinetic investigations are consistent with the identification of key interactions in the structural models and demonstrate that enantiospecificity is coordinated by the interactions of a number of residues in RdpA and SdpA. Most significantly, residues Phe171 in RdpA and Glu69 in SdpA apparently act by hindering the binding of the wrong enantiomer more than the correct one, as judged by the observed decreases in Km when these side chains are replaced by Ala.