医务人员服务积极性认知现状调查与分析

?????? 目的 以北京市医院为例,了解现阶段医务人员对积极性的认知现状,探索存在差异的影响因素。方法 问卷调查法并深入访谈法。结果 逾八成的医务人员对积极性至少有一定程度了解,积极性最重要体现前五项为：自觉履行救死扶伤的宗旨;良好的医疗质量;适宜的工作量使患者能得到妥善救治;快捷的服务效率;过度医疗。近八成的医务人员认为员工积极性正在削弱,积极性削弱最重要原因前五项为：付出与所得不相称;医患关系不和谐;缺乏职业安全感;工资待遇低;工作的不到应有的认可、重视、尊重。逾九成的医务人员认为应调动员工积极性,积极性调动最重要措施前五项为：建立健全公平公正、科学合理的薪酬机制;和谐医患关系;营造良好的执业环境;员工意见和建议受认可、重视、尊重的程度;建立健全公平公正、科学合理的绩效考评制度。对积极性认知的主要影响因素有性别、婚姻状况、文化程度、工作年限、岗位、部门、编制、月收入等。结论 积极性认知有较广泛的群众基础,开展医务人员服务积极性认知现状调查,熟悉相关影响因素,有利于从源头上为切实落实“调动积极性”提供一个参考的视角。     

阴山山脉乌拉山段种子植物区系组成及特征研究

通过对阴山山脉乌拉山段种子植物区系进行调查、统计、排序,从科、属、种3个分类等级上对植物的地理分布类型、生活型、水分生态类型分别进行统计分析,并与内蒙古种子植物区系进行对比分析。结果表明:(1)乌拉山有野生种子植物67科,227属,426种,其中,裸子植物3科,5属,7种;双子叶植物58科,187属,345种;单子叶植物6科,35属,74种;(2)从地理成分来看,温带成分占绝对优势;生活型以草本植物占绝对优势;从水分生态类型看,中生植物是该区的主要成分,旱生植物在本区系也占有相当比重,说明该地区水分条件较差,在气候区上属于半干旱地区;(3)与毗邻山地植物区系的相似性分析表明,乌拉山植物区系与九峰山、大青山种子植物区系具有很近的亲缘关系,与狼山亲缘关系较远。     

住院医师对规范化培训制度的认知态度调查

????? 目的 了解上海市住院医师规范化培训制度实施1年来住院医师对培训的认知与态度状况,为发现培训中的问题、提出改进意见提供信息支持。方法 对上海市2010年招录的住院医师进行抽样问卷调查。结果 住院医师对规范化培训的认知情况较好,仅有0.89%的人认为自己对医院的培训工作完全不了解;对于培训的态度也比较积极,占总数56.37%的人认为参加培训使自己在未来工作中有一定优势;对培训的总体满意度也较高,但其中薪酬满意度仅2.88。结论 上海市住院医师规范化培训一年来取得了一定成效,2010年招录的住院医师培训对培训政策的认识不断加深,态度与看法正面积极,在培训内容、基地设施、带教水平、师资为人和带教积极性方面的满意程度也较高。建议从更加细致化和规范化的角度来完善政策。

     

我国护理人员绩效考核的发展研究

目的 了解我国护理人员绩效考核的现状及其发展趋势,分析目前我国护理人员绩效考核体系的结构,为建立完善、有效的护理人员考核体系提供思路。 方法 检索中文数据库中核心期刊上公开发表的关于护理人员绩效考核的论文,对其进行描述性和半定量分析。 结果 我国护理人员的绩效考核经历了从经验性介绍到应用性研究的过程,研究方法逐渐由描述性向方法学研究发展。结论 目前国内关于护理人员考核体系的种类较多,缺乏统一的标准,考核结果在全国范围内缺乏可比性。

     

The ins and outs of biological zinc sites

The inner shell coordination properties of zinc proteins have led to the identification of four types of zinc binding sites: catalytic, cocatalytic, structural, and protein interface. Outer shell coordination can influence the stability of the zinc site and its function as exemplified herein by the zinc sites in carbonic anhydrase, promatrix metalloproteases and alcohol dehydrogenase. Agents that disrupt these interactions, can lead to increased off rate constants for zinc. d-penicillamine is the first drug to inhibit a zinc protease by catalyzing the removal of the metal. Since it can accept the released zinc we have referred to it as a catalytic chelator. Agents that catalyze the release of the metal in the presence of a scavenger chelator will also inhibit enzyme catalysis and are referred to as enhanced dechelation inhibitors.     

Pistil anatomy and pollen tube development in Polygala vayredae Costa (Polygalaceae)

Low seed ovule ratios have been observed in natural populations of Polygala vayredae Costa, a narrowly endemic species from the oriental pre-Pyrenees. To evaluate physical and nutritional constraints and pollen tube attrition in this endemic species, stigma and style anatomy, as well as pollen tube development along the pistil were investigated using light and fluorescence microscopy. The structural morphology of the stigmatic region was also examined with scanning electron microscopy. Pollen grains that reached the stigmatic papillae came into contact with a lipid-rich exudate and germinated easily. Although a large number of pollen grains reach the stigmatic papillae, few pollen tubes were able to grow into the style towards the ovary. The style was hollow, with the stylar channel beginning a few cells below the stigmatic papillae. Initially, the stylar channel area was small compared to other levels of the style, and was surrounded by lipid-rich, highly metabolic active cells. Furthermore, lipid-rich mucilage was detected inside the stylar channel. At subsequent style levels towards the ovary, no major reserves were detected histochemically. The reduced intercellular spaces below the stigmatic papillae and the reduced area of the stylar channel at its commencement are suggested to physically constrain the number of pollen tubes that can develop. In subsequent levels of the style, the stylar channel could physically support a larger number of pollen tubes, but the lack of nutritional reserves cannot be disregarded as a cause of pollen tube attrition. Finally, the number of pollen tubes entering the ovary was greater than the number of ovules, suggesting that interactions occurring at this level play a major role in the final reproductive outcome in this species.     

Tryptophanase in aqueous methanol: the solvent effects and a probable mechanism of the hydrophobic control of substrate specificity

To shed light on the mechanism of hydrophobic control in reactions of microbial tryptophanase the direct effect of the solvent hydrophobicity on affinities of amino acid inhibitors was first examined. Values of inhibition constants (K_i) for a variety of amino acids were determined in 37.5% aqueous methanol, and no general correlation between the change of K_i, on passing from water to aqueous methanol, and amino acid hydrophobicity was found. The solvent effects on the separate stages of the external aldimine formation (K_D) and deprotonation to form a quinonoid intermediate (K_q) were determined for the reactions of tryptophanase with 2-oxindolyl- -alanine and -alanine by stopped-flow technique. For 2-oxindolyl- -alanine, which is a close transition-state analogue for the enzyme reaction with natural substrate, the decrease in the affinity in aqueous methanol is associated exclusively with the α-proton abstraction stage but not with the preceding formation of external aldimine. We conclude that the environment of amino acid side chains in the active site cannot be considered to be permanently hydrophobic irrespective of the bound amino acid. We suggest that complexes of tryptophanase with amino acids may exist either in a hydrophobic, presumably “closed”, conformation, where bound amino acids are isolated from the solvent, or in an accesible to solvent, “open”, conformation, depending on the structure of the bound amino acid and stage of the catalytic mechanism. For 2-oxindolyl- -alanine the transfer from an open to a closed conformation probably accompanies deprotonation of the external aldimine. The change of the active site hydrophobicity may provide an efficient way of modulating the relative acid–base properties of the catalytic groups to ensure the movement of protons in the “correct” direction depending on the elementary stage of catalysis.     

Enzyme catalysis via control of activation entropy: site-directed mutagenesis of 6,7-dimethyl-8-ribityllumazine synthase

6,7-Dimethyl-8-ribityllumazine synthase (lumazine synthase) catalyses the penultimate step in the biosynthesis of riboflavin. In Bacillus subtilis, 60 lumazine synthase subunits form an icosahedral capsid enclosing a homotrimeric riboflavin synthase unit. The ribH gene specifying the lumazine synthase subunit can be expressed in high yield. All amino acid residues exposed at the surface of the active site cavity were modified by PCR assisted mutagenesis. Polar amino acid residues in direct contact with the enzyme substrates, 5-amino-6-ribitylamino-2,4(1H,3H)-pyrimidinedione and 3,4-dihydroxy-2-butanone 4-phosphate, could be replaced with relative impunity with regard to the catalytic properties. Only the replacement of Arg127, which forms a salt bridge with the phosphate group of 3,4-dihydroxy-2-butanone 4-phosphate, reduced the catalytic rate by more than one order of magnitude. Replacement of His88, which is believed to assist in proton transfer reactions, reduced the catalytic activity by about one order of magnitude. Surprisingly, the activation enthalpy deltaH of the lumazine synthase reaction exceeds that of the uncatalysed reaction. On the other hand, the free energy of activation deltaG of the uncatalysed reaction is characterised by a large entropic term (TdeltaS) of -37.8 kJmol(-1), whereas the entropy of activation (TdeltaS) of the enzyme-catalysed reaction is -6.7 kJmol(-1). This suggests that the rate enhancement by the enzyme is predominantly achieved by establishing a favourable topological relation of the two substrates, whereas acid/base catalysis may play a secondary role.     

Synthesis of ester-linked lithocholic acid dimers

Four lithocholic acid dimers were synthesised via esterification. The ester-linked dimer, 3-oxo-5beta-cholan-24-oic acid (cholan-24-oic acid methyl ester)-3-yl ester, (3alpha,5beta), was obtained by condensation of methyl lithocholate with 3-oxo-5beta-cholan-24-oic acid. Borohydride reduction of this ester-linked dimer gave 3alpha-hydroxy-5beta-cholan-24-oic acid (cholan-24-oic acid methyl ester)-3-yl ester, (3alpha,5beta), which was acetylated to 3alpha-acetoxy-5beta-cholan-24-oic acid (cholan-24-oic acid methyl ester)-3-yl ester, (3alpha,5beta). Reaction of methyl lithocholate with oxalyl chloride yielded the oxalate dimer, bis(5beta-cholan-24-oic acid methyl ester)-3alpha-yl oxalate.