医疗机构合理用药评价模型的构建研究

目的 针对医疗机构的合理用药水平进行评价研究。方法 根据医疗机构合理用药的具体要求,构建医疗机构合理用药评价指标体系,采用基于模糊群决策的方法和多指标评价分析法构建医疗机构合理用药评价模型。结果 构建了基于模糊群决策的医疗机构合理用药评价模型,并通过实例分析证明了评价模型的可行性。结论 建立的基于模糊群决策的医疗机构合理用药评价模型能够对医疗机构的合理用药水平进行科学评价,为提高医疗机构合理用药水平奠定基础。     

公立医院绩效评价PATH优化模型实证研究 ——基于齐齐哈尔市第一医院的实践

目的 验证公立医院绩效考核“PATH优化模型”指标体系的可行性。方法 按照指标要求进行数据采集与测算,根据实证医院实际情况确定指标值,进行模型模拟,测算结果,论证模型的可操作性。 结果 公立医院绩效考核“PATH优化模型”在稳定的评价维度下,指标设计具有一定的灵活性,医院可根据阶段性目标的达成情况对指标进行动态调整;在规范化管理基础较好、绩效管理信息系统建设完善的医院,指标数据的收集可实现准确、便捷。结论 公立医院绩效考核“PATH优化模型”具有较好的可行性。     

基于病例分型原理的病种难易度评估模型研究

目的 基于病例分型理论,建立病种难易度评估模型,并将病例分型结果作为医疗服务绩效评价的客观依据。方法 对历史病案数据进行回顾性分析,明确影响病种难易度的关键指标及权重,构建病例分型判别公式。结果 建立基于信息平台的病例分型的管理模型。结论 利用病例分型管理,能够客观地评价医疗诊疗水平,促进医院内涵建设。     

基于单细菌共焦拉曼光谱的细菌快速检测

【背景】目前利用共焦拉曼光谱技术进行成像和成分鉴别方面的研究较多,但如何快速检测与鉴别多种细菌方面的研究较少。【目的】基于共焦拉曼光谱技术,建立一种在单细菌水平上实现病原微生物快速分类鉴定的方法。【方法】以大肠杆菌为研究对象,利用共焦拉曼光谱技术在单细菌水平上进行了激发波长的优化试验,并研究了大肠杆菌存放时间对单细菌拉曼光谱信息的影响。同时,对白色葡萄球菌、大肠杆菌、金黄色葡萄球菌、沙门氏菌和铜绿假单胞菌进行了共焦拉曼光谱测试,并对5种细菌进行单细菌拉曼光谱的归属分析,设计共焦拉曼光谱技术结合支持向量机(support vector machine,SVM)模型学习算法,进行了5种细菌的快速分类鉴别。【结果】对于单细菌拉曼光谱探测,532、633和785 nm这3种常见的拉曼探测波长中,532 nm具有更好的激发效率和光谱信噪比。结合SVM模型对5种细菌的识别分类,SVM模型的灵敏度和特异性达到了96.00%以上,整体准确率为98.25%。不同存放时间下大肠杆菌拉曼光谱的重复性和稳定性都很好,且SVM模型匹配率均在90.00%以上。【结论】单细菌拉曼光谱结合SVM模型可对5种细菌进行快...     

建立面向数据价值的眼科临床教学模式探讨

目的 建立面向数据价值的眼科教学模式。方法 通过分析医院医疗大数据价值和教学的关系以及面向数据价值的眼科教学模式,提出了将临床、教学、科研、管理过程中产生的数据进行优化组合。结果 信息时代的医疗、科研电子数据成了眼科教学的主体。结论 充分发挥数据价值,实现眼科教学的数据模型化。

     

Novel moment closure approximations in stochastic epidemics

Moment closure approximations are used to provide analytic approximations to non-linear stochastic population models. They often provide insights into model behaviour and help validate simulation results. However, existing closure schemes typically fail in situations where the population distribution is highly skewed or extinctions occur. In this study we address these problems by introducing novel second-and third-order moment closure approximations which we apply to the stochastic SI and SIS epidemic models. In the case of the SI model, which has a highly skewed distribution of infection, we develop a second-order approximation based on the beta-binomial distribution. In addition, a closure approximation based on mixture distribution is developed in order to capture the behaviour of the stochastic SIS model around the threshold between persistence and extinction. This mixture approximation comprises a probability distribution designed to capture the quasi-equilibrium probabilities of the system and a probability mass at 0 which represents the probability of extinction. Two third-order versions of this mixture approximation are considered in which the log-normal and the beta-binomial are used to model the quasi-equilibrium distribution. Comparison with simulation results shows: (1) the beta-binomial approximation is flexible in shape and matches the skewness predicted by simulation as shown by the stochastic SI model and (2) mixture approximations are able to predict transient and extinction behaviour as shown by the stochastic SIS model, in marked contrast with existing approaches. We also apply our mixture approximation to approximate a likehood function and carry out point and interval parameter estimation.     

Analysis of chemotactic bacterial distributions in population migration assays using a mathematical model applicable to steep or shallow attractant gradients

The mathematical model developed by Riveroet al. (1989,Chem. Engng Sci. 44, 2881–2897) is applied to literature data measuring chemotactic bacterial population distributions in response to steep as well as shallow attractant gradients. This model is based on a fundamental picture of the sensing and response mechanisms of individual bacterial cells, and thus relates individual cell properties such as swimming speed and tumbling frequency to population parameters such as the random motility coefficient and the chemotactic sensitivity coefficient. Numerical solution of the model equations generates predicted bacterial density and attractant concentration profiles for any given experimental assay. We have previously validated the mathematical model from experimental work involving a step-change in the attractant gradient (Fordet al., 1991Biotechnol. Bioengng.37, 647–660; For and Lauffenburger, 1991,Biotechnol. Bioengng,37, 661–672). Within the context of this experimental assay, effects of attractant diffusion and consumption, random motility, and chemotactic sensitivity on the shape of the profiles are explored to enhance our understanding of this complex phenomenon. We have applied this model to various other types of gradients with successful intepretation of data reported by Dalquistet al. (1972,Nature New Biol. 236, 120–123) forSalmonella typhimurum validating the mathematical model and supportin the involvement of high and low affinity receptors for serine chemotaxis by these cells.     

Are the responses of plant species to Quaternary climatic changes idiosyncratic? A demographic perspective from the Western Alps

Background: Previous studies have indicated that several plant species had shown remarkable resistance to Pleistocene climate changes and survived the Last Glacial Maximum in scattered ice-free refugia within the European Alps and peripheral areas nearby. The ‘Expansion–Contraction’ model has been proposed to describe the responses of organisms to Pleistocene climate change. Nevertheless, the timing and extent to which species were affected by Quaternary glaciations remain uncertain.

Aims: To test whether the ‘Expansion–Contraction’ model appropriately describes plant distribution responses to Pleistocene climate change in the Western Alps.

Methods: We employed two Bayesian coalescent-based methods on plastid DNA sequences to infer the demographic histories of Ranunculus kuepferi, R. glacialis, Biscutella laevigata, Saxifraga oppositifolia, Primula allionii, P. marginata, Silene cordifolia and Viola argenteria.

Results: R. kuepferi conformed to the ‘Expansion–Contraction’ model, while other species did not. For example, P. allionii showed an alarming population decline during the Middle-Late Pleistocene.

Conclusions: The application of Bayesian coalescent-based methods to plastid DNA data offers useful insights into plant demography as a function of palaeoclimatic events. Our findings favour an idiosyncratic response of plant species in the Western Alps to Pleistocene climate change.     

Cancer models,genomic instability and somatic cellular Darwinian evolution

   

The biology of cancer is critically reviewed and evidence adduced that its development can be modelled as a somatic cellular Darwinian evolutionary process. The evidence for involvement of genomic instability (GI) is also reviewed. A variety of quasi-mechanistic models of carcinogenesis are reviewed, all based on this somatic Darwinian evolutionary hypothesis; in particular, the multi-stage model of Armitage and Doll (Br. J. Cancer 1954:8;1-12), the two-mutation model of Moolgavkar, Venzon, and Knudson (MVK) (Math. Biosci. 1979:47;55-77), the generalized MVK model of Little (Biometrics 1995:51;1278-1291) and various generalizations of these incorporating effects of GI (Little and Wright Math. Biosci. 2003:183;111-134; Little et al. J. Theoret. Biol. 2008:254;229-238).     

A model of cell firing patterns during epileptic seizures

A simplified model is presented of the dynamics of excitatory and inhibitory neurons in the cerebral cortex. A key feature of the model is that neurons may cease to fire when strongly depolarized (spike inactivation). Computer simulations for different parameters reveal five classes of solutons: a) steady states in which neither excitatory nor inhibitory cells are active, b) steady states in which one or both types of cells fire repetitively, c) states in which one type of cell fluctuates rapidly between bursts of action potentials and inactivity due to strong depolarization, d) rhythmic activity in which both types of cells fire in unison followed by a period of spike inactivation and e) states similar to d but in which the inhibitory cells never produce action potentials. Solutions b, c, d, and e qualitatively resemble the different firing patterns observed during experimental seizures. It is shown that changes in those parameters that are functions of potassium concentration can induce changes in the type of solution. It is therefore proposed that the increase in extracellular potassium concentration during seizures may be responsible for the progressive changes observed in firing patterns and particularly for the transition from tonic to clonic patterns. A method is also outlined for testing the predictions of the model.     

基于探索性因子分析的输血科人员胜任力模型构建

??????? 目的 构建医院输血科室人员胜任力模型。方法 采用横断面问卷调查收集数据,采用探索性因子分析对胜任力模型内部结构进行分析。 结果 医院输血科室人员胜任力模型包含了6个公因子和24个特征指标,维度分别为：专业技能、个人特质、能力素质、防控差错、遵守规范和职业素养。结论 构建医院输血科室人员胜任力模型可以极大的丰富医院人力资源管理策略,在甄选、培训和绩效测评输血科室人员等方面具有积极的现实意义。     

Evolutionary conservation of angiosperm flower development at the molecular and genetic levels

Flowers consist primarily of four basic organ types whose relative positions are universally conserved within the angiosperms. A model has been proposed to explain how a small number of regulatory genes, acting alone and in combination, specify floral organ identity. This model, known widely as the ABC model of flower development, is based on molecular generic experiments in two model organisms,Arabidopsis thaliana and Antirrhinum majus.Both of these species are considered to be eudicots, a clade within the angiosperms with a relatively conserved floral architecture. In this review, the application of the ABC model derived from studies of these typical eudicot species is considered with respect to angiosperms whose floral structure deviates from that of the eudicots. It is concluded that the model is universally applicable to the angiosperms as a whole, and the enormous diversity seen among angiosperms flowers is due to genetic pathways that are downstream, or independent, of the genetic programme that specifies floral organ identity.     

基于Kano模型的三甲医院门诊服务调查分析

目的 以西部一所综合性三级甲等医院为例,验证kano模型应用在三级甲等医院门诊服务内容调查分析中的可行性与开展后的应用效果。方法 运用自行设计的kano调查问卷,对门诊700名就诊的患者开展调查,通过kano模型质量属性分类方法将门诊服务内容进行归类。结果 本次门诊服务内容按照kano质量属性的分类为必备质量、一维质量、魅力质量、逆向质量的分别有8项、8项、3项、2项。结论 kano模型应用在三级甲等医院门诊服务内容的分类中能够从定性层次上挖掘出服务需方对医疗机构潜在的服务需求。一次卓有成效的管理,在控制基本质量的同时,我们还需要不断完善一维质量与创造魅力质量。     

三级医院医疗质量评价指标体系的构建及优化

目的 在原有医疗质量评价体系的基础上,建立一套科学合理、可操作性强的三级综合性医院医疗质量评价指标体系。方法 采用典型研究方法,通过文献研究筛选初始指标,通过知情人访谈法确定质量评价框架,运用德尔菲法并借鉴平衡积分卡的原理和思想优化并确定指标及权重系数。结果 确定了以医疗基础质量、环节质量和终末质量为基本结构的三级综合性医院质量评价框架和指标体系,由3个一级维度、8个二级维度、24个三级维度指标体系及其相应权重。结论 医疗质量评价指标体系关注医院质量管理中的难点和重点环节,能够满足上海市三级综合性医院医疗质量管理的实际需要。     

The relationship of the phase and amplitude of the annual cycle of CO2 to phenological events

Background: A key current issue in studies of global CO₂ is the cause of the recent pronounced changes in the timing (phase) and amplitude of its annual cycle.

Aim: To use a sensitivity analysis in order to identify the most influential parameters in a new four-box diffusion model of global CO₂ transport.

Methods: A new diffusion model of global atmospheric transport is developed, implemented by optimisation and used to assess the effects of oceanic, terrestrial and anthropogenic CO₂ fluxes on the annual CO₂ cycle. As the terrestrial phenology of living organisms in the temperate zones is identified as the central process of concern an improved phenological model for the temperate zones is proposed and used in up-scaling from plant to planet.

Results: The diffusion model is found to be able to mimic many of the features observed by the GLOBALVIEW-CO₂ network, including the global trend, latitudinal gradient, and annual waveform.

Conclusions: It is concluded that, out of five rival hypotheses considered at the outset, the springtime phenology of terrestrial biomes is the dominant controller of recent changes to the annual CO₂ cycle.     

基于国际认证标准的医疗耗材供应链安全能力建设

目的 以符合目前世界公认最高的国际医疗机构相关认证标准为目标,建立模型加强医疗耗材供应链安全能力,保护患者和员工免受污染、伪劣和用途改变产品的危害。 方法 根据供应链安全模型,医疗耗材供应链管理的设计上采取了相应的措施 结果 提高了医疗耗材供应链安全能力,降低风险,符合在医院物流方面的更高品质要求 结论 将供应链安全模型运用于医疗耗材供应链管理中,能有效加强医疗耗材供应链安全能力。     

新生隐球菌半胱氨酸转运蛋白Mup1鉴定及其表达调控研究

【目的】鉴定新生隐球菌(Cryptococcus neoformans)的半胱氨酸转运蛋白及其对致病性的影响。【方法】构建候选基因敲除株,检测突变株以半胱氨酸为唯一硫源的生长情况;检测半胱氨酸转运蛋白Mup1对新生隐球菌毒力因子表达和不同胁迫条件下生长的影响;通过新生隐球菌大蜡螟(Galleria mellonella)和小鼠感染模型分析Mup1对致病性的影响;通过转录组分析和酵母单杂交研究硫代谢核心转录因子Cys3与Mup1的调控关系。【结果】Mup1具有转运半胱氨酸、胱氨酸、胱硫醚和同型半胱氨酸的能力。基因MUP1缺失不影响毒力因子表达和细胞对应激的反应。大蜡螟和小鼠隐球菌感染模型表明Mup1对新生隐球菌的致病性无显著影响。转录组分析和酵母单杂交实验显示Cys3可能间接调控MUP1的转录。【结论】新生隐球菌Mup1具有转运半胱氨酸、胱氨酸、胱硫醚和同型半胱氨酸的功能,但不影响致病性,基因转录可能受Cys3的间接调控。     

排队论模型在军队医院门诊超声科设备配置中的应用

目的 探讨排队论模型在军队医院门诊超声科设备配置中的应用效果。方法 运用现场调查法和排队论模型,计算超声科设备工作强度（r）,患者排队等待人数（Lq）,窗口逗留人数（Ls）,平均排队等待时间（Wq）,平均逗留时间（Ws）,设备空闲概率（P0）患者到达必须等待的概率（P）等运行指标,并对应用排队论模型配置设备前后患者及技师进行满意度调查。结果 超声科上下午分别配置6台和3台设备较为合理,在应用排队论模型配置设备后,技师和患者的满意度均得到明显提高（P＜0.05）。结论 利用排队论的方法可以较好地配置超声科设备,为提高服务效率提供科学参考。     

3D pharmacophore models for thromboxane A2 receptor antagonists

Thromboxane A₂ (TXA₂) is an endogenous arachidonic acid derivative closely correlated to thrombosis and other cardiovascular diseases. The action of TXA₂ can be effectively inhibited with TXA₂ receptor antagonists (TXRAs). Previous studies have attempted to describe the interactions between the TXA₂ receptor and its ligands, but their conclusions are still controversial. In this study, ligand-based computational drug design is used as a new and effective way to investigate the structure-activity relationship of TXRAs. Three-dimensional pharmacophore models of TXRAs were built with HypoGenRefine and HipHop modules in CATALYST software. The optimal HypoGenRefine model was developed on the basis of 25 TXRAs. It consists of two hydrophobic groups, one aromatic ring, one hydrogen-bond acceptor and four excluded volumes. The optimal HipHop model contains two hydrophobic groups and two hydrogen-bond acceptors. These models describe the key structure-activity relationship of TXRAs, can predict their activities, and can thus be used to design novel antagonists. Figure Optimal three-dimensional pharmacophore models of TXA₂ receptor antagonists (TXRAs) built with HypoGenRefine (a) and HipHop (b) modules. a Hypo-1 model mapped with compounds 11 (purple), and 20 (green). b Hypo-2 model mapped with compounds 31 (green) and 64 (yellow). Spheres: Green Hydrogen bond acceptors (HBA), cyanhydrophobic (H), orange aromatic rings (RA), black excluded volumes (EV) Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.