Careers in academic general practice: problems,constraints, and opportunities.

Changing priorities in the NHS have underlined the crucial importance of academic general practice in providing quality training and research to underpin developments in general practice. Unfortunately, several problems and constraints mean that the full potential of general practitioners to make a contribution to teaching and research has not been realised. These issues are examined and recommendations for improvements are made. Obstacles to career development for academics in general practice should be removed. The funding of academic general practice should be the same as for other medical disciplines. Vocational training for general practice should be extended to include research and audit methods, particularly for doctors interested in an academic career. Above all, the long term objective should be to integrate undergraduate and post-graduate general practice to increase the overall effectiveness of teaching and research and hence the quality of service general practice.     

Is the Jarman underprivileged area score valid?

A recently published validation of an underprivileged area score, which is intended to reflect factors that increase general practice workload or pressure on their services, was incomplete; a validation based on criteria other than the opinion of general practitioners is also required. Areas with higher mortality from diseases where general practitioner intervention can reduce mortality substantially are likely to have a greater need for general practice services. Similarly, the need for general practitioner services should be higher where the incidence of such treatable conditions is higher. This paper describes the association between Jarman''s score and (a) mortality from causes that are amenable to general practice intervention and (b) incidence of two diseases where general practice intervention is important. Using these data the score appears to have external criterion validity and thus is likely to reflect, at least crudely, the need for general practitioner services.     

海南省二级综合医院感染管理现状与展望

结合近年国内外对医院感染管理的研究进展，立足于海南省本土地区的实际，对海南省二级综合医院感染管理现状进行系统的调查研究。基于海南省二级综合医院感染的组织建立、制度建立、感染管理活动开展、重视程度等方面现状，分析海南省二级综合医院感染管理的地域化特征；针对海南省二级综合医院感染管理的现状，提出符合地域特性的科学化管理对策与依据。     

全麻药作用的脊髓机制研究

全麻药对脊髓有着广泛和复杂的作用,深入研究全麻药作用的脊髓机制,无疑有助于全麻药在临床上的合理应用和对全麻药作用机制的认识。本文综述了全麻药对脊髓内神经元、神经元间的突触传递、相关受体及离子通道的作用。     

Multiplicity of the Amino Acid Permeases in Saccharomyces cerevisiae IV. Evidence for a General Amino Acid Permease

Kinetic and genetic evidences are presented to show that, in addition to specific amino acid permeases, Saccharomyces cerevisiae has a general amino acid permease which catalyzes the transport of basic and neutral amino acids, but most probably not that of proline. The general amino acid permease appears to be constitutive, and its activity is inhibited when ammonium ions are added to the culture medium. A mutant which has lost the general amino acid permease activity was isolated. Its mutation, named gap (general amino acid permease), is not allelic to the aap (amino acid permease) mutation of Surdin et al., which has a quite different phenotype and cannot be considered as having selectively lost the general amino acid permease activity.     

An elastic model of the large-scale structure of duplex DNA.

A general model for the large-scale, time-independent structure of duplex DNA is developed based on elastic considerations. The general conditions of elastic equilibrium are given. These equations are solved for the equilibrium shape of stressed duplex DNA, based on the assumption that the double helix behaves mechanically as a symmetric, linearly elastic rod. It is shown that, in general, two orders of superhelicity will arise at equilibrium. Several possible applications of this approach to the supercoiling of closed circular DNA are described.     

Higher professional training in general practice: provision of master's degree courses in the United Kingdom in 1993.

Review of a 1993 survey of the 29 United Kingdom departments of general practice (or equivalent) identified seven master''s degree courses available for general practitioners. Up to another 11 are planned within the next five years. Around 50 general practitioners undertake all such courses at any one time. Possible reasons for this low uptake include cost, lack of flexibility of courses, and the prospect of writing a thesis. Appropriate master''s courses are essential to the future development of general practice, and this paper postulates the characteristics of an "ideal" course.     

土茯苓中提取总黄酮的工艺研究

采用乙醇溶液提取土茯苓饮片中总黄酮,分析了乙醇浓度、温度、固液比、浸取时间对总黄酮提取率的影响。进行了单因素实验设计,得出优化实验条件：乙醇浓度50%,浸取温度80℃,固液比1:20,浸取时间3h,总黄酮提取率为75.8%。     

Phytoenzyme systems as models for an understanding of general metabolic pathways.

A comparison is made between certain aspects of lipid metabolism in plant and animal tissues. While the general biochemical reactions are identical, a number of important variations are described and related to the general metabolic activities of the tissues.     

Optimal intervention for epidemic models with general infection and removal rate functions

 In this paper, known results on optimal intervention policies for the general stochastic epidemic model are extended to epidemic models with more general infection and removal rate functions. We consider first policies allowing for the isolation of any number of infectives from the susceptible population at any time, secondly policies allowing for the immunisation of the entire susceptible population at any time, and finally policies allowing for either of these interventions. In each case the costs of infection, isolation and immunisation are assumed to have a particular, rather simple, form. Sufficient conditions are given on the infection and removal rate functions of the model for the optimal policies to take the same simple form as in the case of the general stochastic epidemic model. More general costs are briefly discussed, and some numerical examples given. Finally, we discuss possible directions for further work. Received: 16 February 1999     

Anglo-Canadian Exchange in General Practice: British View of Canadian General Practice

The Canadian general practitioner is remunerated by an item-of-service system of payment which encourages servicing demands rather than needs, discourages delegation of work to paramedical workers, and involves his staff in a massive amount of paper work. He has an excellent hospital attachment, which unfortunately is overdone. His community facilities are piecemeal and his office organization is rudimentary. There are few incentives for good general practice in the community. He spends an inordinate amount of time examining well people. The university departments of general practice are extremely good and much should be heard from them very quickly. The patient''s attitude towards his doctor is quite different from the one prevailing currently in Britain.I returned happily to British general practice.     

General medicine in the 'eighties.

The general physician with or without an interest is directly responsible for the initial and continuing care in most acute medicine. Specialty interests cover the whole range of medicine but in most instances are subordinate to the claims of general medicine. Consultants in district general hospitals carry a bigger caseload in acute medicine than their colleagues in teaching hospitals, and this has implications for undergraduate and postgraduate training. The management of patients in intensive care units remains very much the task of the general physician. The general physician will continue to be an essential member of the hospital service in the foreseeable future.     

全科医学人才培养与继续教育形式的探讨

在分析全科医学人才培养现状的基础上,提出了开展全科医学人才培养和继续教育的必要性。探讨提高全科医师社区服务技能的办法,分析当前落实新医改工作中出现的矛盾和存在的关键问题,并提出在社区卫生服务工作中,要采取最好的学习方式和选择适合基层服务的内容来培养全科医学合格人才。     

Variables aggregation in a time discrete linear model

In this work we extend approximate aggregation methods to deal with a very general linear time discrete model. Approximate aggregation consists in describing some features of the dynamics of a general system in terms of the dynamics of a reduced system governed by a few global variables. We present a time discrete model for a structured population (i.e., the population is subdivided in subpopulations) in which we can distinguish two processes of a general nature and whose corresponding time scales are very different from each other. We transform the general system to make the global variables appear and obtain the reduced system. These global variables are, for each subpopulation, a certain linear combination of the corresponding state variables. We show that, under quite general conditions, the asymptotic behavior of the reduced system can be known in terms of the corresponding behavior for the reduced system. The general method is applied to aggregate a multiregional Leslie model in which the demographic process is supposed to be fast with respect to migration.     

通识教育中融入人类遗传学的教学实践

通识教育已经成为大学高等教育的重要组成部分,强调通专结合的办学理念,要求践行“以人为本”的教育实践。在教学实践中存在不少困难和困惑,需要不断总结和发展中国特色的通识教育体系。本文凝练了在人类生物学教学实践中如何融入人类遗传学知识的通识教学理念、案例和分析,以“人是什么”为切入点引入贴近生活的教学内容。通过现代进化基因组学知识,解析人类自身发展的过去、现在和未来所涉及的生物学核心问题。剖析人的经典属性及其与通识教育的特殊关联,进而引出基于问题的深层次思考。     

Sources and patterns of referrals of oral cancer: role of general practitioners.

Referrals of patients with oral squamous cell carcinomas to an oral medicine clinic were assessed with regard to the sources, delays, and pattern of referrals from general medical practitioners and general dental practitioners. Slightly more patients were referred by dental practitioners than by medical practitioners, but general medical practitioners were far more likely to see advanced tumours and to request an urgent second opinion or suggest a diagnosis of malignant disease. The greatest delay overall was caused by the patients in seeking advice from their practitioner, particularly those who attended a general medical practitioner. Both groups of practitioners requested a hospital opinion within roughly a month--a reasonable interval. Subsequent delays were minimal. Delays occur mainly because the patients are slow in seeking professional advice and, in general, do not appear to have been reduced over the decade since a previous British study on referral patterns was carried out. This study emphasises the importance of educating patients about oral cancer since it is they who appear to be mainly responsible for the delays in diagnosis. The results also help to dispel the myth that general medical practitioners might be less competent at diagnosis and referral of patients with oral cancer than are dental practitioners, though we are aware of misdiagnoses from both groups.     

Multivariate measures of similarity and niche overlap

Niche overlap measures are used to assess the similarity in resource use by two species. Recently researchers have used niche overlap measures as summary measures and for making inferences, typically about competition for resources. The problem of estimating niche overlap when the niches are multivariate normal distributions with equal covariance matrices has previously been studied. In this work, the assumption of equal covariance matrices is relaxed. Two general measures of similarity are evaluated assuming general multivariate normal distributions. Commonly used measures of overlap are given as special cases of these two general measures. The question of bias in estimating these measures is discussed and shown to be a potential problem, especially when there are many redundant variables or if sample sizes are small.     

On the formal theory of nerve conduction

A general solution of the formal nerve conduction problem is given. As illustrations of the general method, the capacitative single-factor and the non-capacitative Lapicque problems are solved. Comparisons between velocity formulae for capacitative and non-capacitative models indicate that previously determined non-capacitative velocities are considerably too high.     

On Ebenman's model for the dynamics of a population with competing juveniles and adults

A general version of a model of Ebenman for the dynamics of a population consisting of competing juveniles and adults is analyzed using methods of bifurcation theory. A very general existence results is obtained for non-trivial equilibria and non-negative synchronous two-cycles that bifurcate simultaneously at the critical valuer=1 of the inherent net reproductive rater. Stability is studied in this general setting near the bifurcation point and conditions are derived that determine which of these two bifurcating branches is the stable branch. These general results are supplemented by numerical studies of the asymptotic dynamics over wider parameter ranges where various other bifurcations and stable attractors are found. The implications of these results are discussed with respect to the effects on stability that age class competition within a population can have and whether such competition is stabilizing or destabilizing. Supported by National Science Foundation Grant No. DMS-8714810.