解剖学工作者的职业病在工作环境中举证责任倒置的探讨

甲醛可引起机体一系列异常反应,针对解剖工作者所处的工作环境,可以通过改善工作环境、使用检测仪器和定期进行体检来预防甲醛对机体的危害,在防治职业病的发生的基础上,认识到职业病在工作环境中的举证责任倒置问题,可以对疾病进行早发现和早治疗,并对职业病的法律维权有所帮助。     

公立医院临床医生对医疗监管认知的调查及分析

??????? 目的 了解临床医生对公立医院医疗监管的认知情况。方法 对新疆医科大学附属医院202名在职临床医生随机进行问卷调查,用卡方检验处理数据。 结果 不同年龄的临床医生对完善医院监管体制是否有助于加强医师职业管理、提高专业技术能力的看法有差异（P＜0.05）;不同年龄、职称、工龄的医生对医院监管制度的认识、对现有监管制度是否得到严格执行的认识和对管理人员的监管意识认识没有差别（P＞0.05）;不同年龄、职称、工龄的医生对于普通员工监管意识的认识有差别（P＜0.05）;对于医院医疗监管存在的问题及原因,大部分医生认识比较清楚,存在的问题符合社会普遍现象。结论 建立完善的医院医疗监管机制,积极探索科学的,系统的监管模式,内部监管与外部监管相结合。     

临床医生工作幸福感现状调查及影响因素分析

目的 了解上海市三级综合医院临床医生工作幸福感现状,分析影响临床医生工作幸福感的多维因素,探索和实践具有实效性和可操作性的改善方法和途径,建立常态长效机制,不断提高临床医生工作幸福感。 方法 以上海市隶属于4个不同系统的8家具有代表性的地方三级综合性医院的临床医生为调查对象进行抽样调查,调查结果使用SPSS19.0软件进行统计,在统计分析过程中运用描述性统计分析和多元逐步线性回归分析等分析方法。 结果 上海市三级综合医院临床医生的积极情感多于消极情感。临床医生的工作幸福感认知处于中等偏上水平,其中对人际关系的幸福感认知较高,对福利报酬的幸福感认知较低。消极情感体验与上海市三级综合医院临床医生工作幸福感呈负相关,积极情感体验与上海市三级综合医院临床医生工作幸福感呈较强的正相关。结论 心理健康状况、收入水平、职业发展是影响上海市三级综合医院临床医生工作幸福感的主要因素。     

审视医疗侵权诉讼举证责任的分配

2009年12月通过的《中华人民共和国侵权责任法》规定了患者因为医疗行为受到损害,要求医疗机构赔偿,需要提供证据证明医方的过错。这就改变了《最高人民法院关于民事诉讼证据的若干规定》第4条的过错及因果关系的双推定原则,在平衡患者和法院举证能力,实现诉讼公平方面具有积极的现实意义。     

医学院校附属医院临床医生科研能力影响因素分析

目的 分析筛选医学院校附属医院临床医生科研的影响因素,为采取干预措施提供依据。方法 选取由38位资深专家采用德尔菲法确定科研产出指标并进行赋值。采用随机抽样的方法对某附属医院的四所附属医院200名临床医生进行问卷调查,采用多因素Logistic回归分析临床医生科研的影响因素。 结果 最终确定了科研能力绩效评价指标体系28个,结果显示国外学习经历、团队情况、科研经费、科研管理规范性4个因素对临床医生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临床医生的科研能力,应该加强临床医生国际交流机会、培养科研团队、增加科研经费的投入以及加强科研管理的规范性。     

城乡医保一体化管理对临床医生工作影响的思考

以医院医保新农合部门管理职工医保、居民医保、新农合工作中遇到的困难为切入点,充分认识城乡医保一体化管理的必要性及迫切性。强调从体制机制上营造宽松条件,避免医务人员在研究不同医保、新农合政策上花费更多的时间,让医生们能有更多的精力致力于临床医学实践和科学研究,从而实现真正意义上的高质量、高效率地满足全民医保需要,从根本上提高全民的医疗保障水平。     

临床医生人文素质现状调查与分析

目的 分析临床医生人文素质现状及其存在的问题,为提高临床医生综合素质提供理论依据和实践指导。方法 采用德尔菲法制定临床医生人文素质评价指标体系;在通过随机抽样法开展现场实证研究的基础上,运用因子分析法验证评价指标体系,并确定各级指标的客观权重值;采用方差分析等方法分析临床医生人文素质现状。结果 方差齐性检验可知,Levene统计量为33.469,P=0.000,样本适合做方差分析。方差分析F=579.665,P=0.000,说明一级指标间得分具有显著性差异。对临床医生人文素质影响因素的探析结果显示,除了年龄维度中的25岁以下组得分显著低于其他年龄组,不同医疗单位间临床医生人文素质得分差异性呈弱显著性外,其他各维度间的得分均无显著性差异。结论 建立一个科学的临床医生人文素质评价指标体系具有重要意义。     

The impact of land conversion on plant biodiversity in the forest zone of Cameroon

Floristic surveys were carried out in different land use systems(primary and secondary forest, fallows of different ages, cocoa plantations,crop fields) within the forest zone of Cameroon, to assess the impact of landconversion on above-ground plant biodiversity. Beside various diversity studies,plant density was measured and diameter at breast height was estimated.The results showed that the forest areas, which represent thehistoric biodiversity of the region, preserve the greatest number of species(160 species in primary forest and 171 in secondary forest). Our resultsindicate the relatively great importance of secondary forests as refuge areasfor primary forest plant species that may function as a starting point forpossible regeneration of original biodiversity. Species richness is reducedprogressively from the original forest (160 spp.) and secondary forests (171spp.), to Chromolaena odorata (Asteraceae) fallow fields(149 spp.), to an old fallow field (139 spp.), to a cocoa plantation (116 spp.)and to the farmland (64 spp.), where only weeds and crops contribute essentiallyto plant biodiversity. Also the number of species that are used for non-timberproducts (construction, food and medicines) decreased with increased landconversion.     

The Precautionary Preference: An American Perspective on the Precautionary Principle

The precautionary principle, a familiar constituent of international and European environmental law, has only very recently entered the vocabulary of domestic environmental policy debates in the United States. The question naturally arises what role such a principle should play in American law. By breaking down statements of the precautionary principle into distinct ele ments, one can more readily find ways in which U.S. law reflects the precau tionary principle. This analysis reveals that American environmental law con tains precautionary elements and goals in many and varied settings, from the management of natural ecosystems, to pollution control standards, to risk assessment methodology. However, the precautionary approach appears in a highly diluted or compromised form. With rare exceptions, U.S. law balances precaution against other considerations, most importantly cost. Therefore, while precautionary elements are firmly entrenched in U.S. environmental law, it is more accurate to say that it reflects a precautionary preference rather than the precautionary principle.     

医生工作站电子申请检验项目时附加费用的智能收取

目的：探讨医生工作站电子申请检验项目时附加费用的智能收取的实现及应用价值。方法：检验单项和检验组套进行分组;每组内先根据标本类型收取采血费和一次卫材费,然后将标本类型同组内样本类型进行比较,不同则加收一次。有多个分组时,每组先加收一次卫材费,然后组内判断循环同上。特殊情况设置特殊的处理方案。结果：临床医生选中检验项目时,采样所需要收取的卫材费及采血费,自动添加到医嘱中。当去掉某一项目时只需删除项目,卫材费及采血费由收费程序判断保留,多余的自动删除。特殊情况实现了按需收取。结论：电子申请检验项目时实现附加费用的智能收取,表明在HIS建设中在注重功能大而全的同时,也需要注重小而精的细节,以求方便日常工作。     

The global burden of metabolic disease: Data from 2000 to 2019

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The completeness and timeliness of cancer registration and the implications for measuring cancer burden

BackgroundPopulation based cancer registration provides a critical role in disease surveillance in terms of incidence, survival, cancer cluster investigations and prevalence trends, and therefore high levels of completeness and timeliness are required. This study estimates completeness and variation between early and late registrations in the N. Ireland Cancer Registry (NICR) and assesses the implications for reporting cancer incidence and for registry-based research.MethodsTwo main approaches assessed completeness. For the period 2010–2012, incidence reported in the first year of data publication was compared to incidence reported in subsequent years until 2015. Demographic characteristics and survival of incident cases ascertained before the first publication year were compared to those ascertained in subsequent years. The flow method approach was used to estimate completeness annually after the incident year.ResultsOverall incidence for all cancers increased between the first year of data publication and subsequent years up to 2015, irrespective of year of diagnosis. Late registrations had poorer survival. The flow method approach estimated the completeness of case ascertainment of NICR data to be 96% complete at five years for all cancers combined.ConclusionThe estimated completeness levels for the NICR are comparable to other high quality cancer registries internationally. While data timeliness has little impact on incidence estimates, delays in registration may have implications for specific research studies into incidence and survival. This means that improvements in the timeliness of reporting should be a target for all registries but not at the expense of completeness.     

The conversion of the Chumash Indians: An ecological interpretation

A 17-year period during which interaction occurred between the Chumash and Spanish colonizers is the focus of the study. Significant variation in subsistence and interactive patterns during this period is identified. The baptismal rite that marked the transition from native villager to mission Indian is interpreted in relation to the environmental and subsistence realities faced by both the Chumash and Spanish.     

Assessing the impact of minimizing arginine conversion in fully defined SILAC culture medium in human embryonic stem cells

We present a fully defined culture system (adapted Essential8^TM [E8^TM] medium in combination with vitronectin) for human embryonic stem cells that can be used for SILAC purposes. Although a complete incorporation of the labels was observed after 4 days in culture, over 90% of precursors showed at least 10% conversion. To reduce this arginine conversion, E8^TM medium was modified by adding (1) l ‐proline, (2) l ‐ornithine, (3) N^ω‐hydroxy‐nor‐l ‐arginine acetate, or by (4) lowering the arginine concentration. Reduction of arginine conversion was best obtained by adding 5 mM l ‐ornithine, followed by 3.5 mM l ‐proline and by lowering the arginine concentration in the medium to 99.5 μM. No major changes in pluripotency and cell amount could be observed for the adapted E8^TM media with ornithine and proline. However, our subsequent ion mobility assisted data‐independent acquisition (high‐definition MS) proteome analysis cautions for ongoing changes in the proteome when aiming at longer term suppression of arginine conversion.     

Characterization of the metabolic burden on Escherichia coli DH1 cells imposed by the presence of a plasmid containing a gene therapy sequence

The presence of a plasmid, containing gene sequences for DNA immunotherapy that are not expressed in microbial culture, imposed a degradation in bioreactor performance in cultures of the host E. coli strain. Significant decreases in growth rate (24%) and biomass yield (7%) and a corresponding increase in overflow metabolism were observed in a strain containing a therapeutic sequence (a hepatitis B antigen under the control of a CMV promotor). The observed increase in overflow metabolism was incorporated into a Metabolic Flux Analysis (MFA) model (as acetate secretion). Metabolic flux analysis revealed an increase in TCA cycle flux, consistent with an increased respiration rate observed in plasmid-containing cells. These effects are thought to result from increased ATP synthesis requirements (24%) arising from the expression of the Kanr plasmid marker gene whose product accounted for 18% of the cell protein of the plasmid-containing strain. These factors will necessitate significantly higher aeration and agitation rates or lower nutrient feed rates in high-density cultures than would be expected for plasmid-free cultures.