继续医学教育项目" 过程管理模式" 体会

继续医学教育项目是开展继续医学教育的重要形式之一,是卫生专业技术人员获取新知识、新理论、新技术、新方法的重要途径。项目执行的质量将直接体现继续医学教育质量。因此规范项目管理程序,建立有效的运行体系,建立严格奖罚制度,进行"过程跟踪管理"是保证项目执行质量的有效措施。     

A fibre optic catheter for simultaneous measurement of longitudinal and circumferential muscular activity in the gastrointestinal tract

Diagnostic catheters based on fibre Bragg gratings (FBG's) are proving to be highly effective for measurement of the muscular activity associated with motility in the human gut. While the primary muscular contractions that generate peristalsis are circumferential in nature, it has long been known that there is also a component of longitudinal contractility present, acting in harmony with the circumferential component to improve the overall efficiency of material movement. We report the detection of longitudinal motion in mammalian intestine using an FBG technique that should be viable for similar detection in humans. The longitudinal sensors have been combined with our previously reported FBG pressure sensing elements to form a composite catheter that allows the relative phase between the two components to be detected. The catheter output has been validated using video mapping in an ex‐vivo rabbit ileum preparation. (© 2011 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)     

What Users Want and May Need

An increasing number of software tools support designers and other decision makers in making design, production, and purchasing decisions. Some of these tools provide quantitative information on environmental impacts such as climate change, human toxicity, or resource use during the life cycle of these products. Very little is known, however, about how these tools are actually used, what kind of modeling and presentation approaches users really want, or whether the information provided is likely to be used the way the developers intended. A survey of users of one such software tool revealed that although users want more transparency, about half also want an easy-to-use tool and would accept built-in assumptions; that most users prefer modeling of environmental impacts beyond the stressor level, and the largest group of respondents wants results simultaneously on the stressor, impact potential, and damage level; and that although many users look for aggregated information on impacts and costs, a majority do not trust that such an aggregation is valid or believe that there are tradeoffs among impacts. Further, our results show that the temporal and spatial scales of single impact categories explain only about 6% of the variation in the weights between impact categories set by respondents if the weights are set first. If the weights are set after respondents specify temporal and spatial scales, however, these scales explain about 24% of the variation. These results not only help method and tool developers to reconsider some previous assumptions, but also suggest a number of research questions that may need to be addressed in a more focused investigation.     

VIEWS OF THE PROCESS AND CONTENT OF ETHICAL REVIEWS OF HIV VACCINE TRIALS AMONG MEMBERS OF US INSTITUTIONAL REVIEW BOARDS AND SOUTH AFRICAN RESEARCH ETHICS COMMITTEES

Given the ethical controversies concerning HIV vaccine trials (HVTs), we aimed to understand through an exploratory study how members of institutional review boards (IRBs) in the United States (US) and research ethics committees (RECs) in South Africa (SA) view issues concerning the process and content of reviews of these studies. We mailed packets of 20 questionnaires to 12 US IRB chairs and administrators and seven REC chairs to distribute to their members. We received 113 questionnaires (76 from the US and 37 from SA). In both countries, members tended to be white males with advanced academic degrees. Compared to the US, SA members called for ‘major changes’ in HVT protocols more frequently (p = 0.004), and were less likely to think that HVT participants understood risks and benefits (p = 0.033) or informed consent forms (p = 0.000). In both countries, members were divided on several critical issues (e.g. the minimum standard for treatment for HVT participants who became infected during the HVT), but agreed that they needed more training. Of the SA respondents, 40% reported that they were ‘self‐taught’ in ethics. This study, the first we know of to offer quantitative data comparing US vs. non‐US IRBs/RECs, thus suggests key similarities and differences (e.g. compared to SA respondents, US respondents appeared to overestimate participants' understanding of informed consent), along with needs for education. These initial exploratory data in this area have important implications for IRBs, RECs, policy‐makers and scholars concerning future practice, training, policy, and investigations in research ethics, and prevention and treatment of HIV and other diseases in the developing world and elsewhere.     

Optimal Bayesian Design for Patient Selection in a Clinical Study

Summary .  Bayesian experimental design for a clinical trial involves specifying a utility function that models the purpose of the trial, in this case the selection of patients for a diagnostic test. The best sample of patients is selected by maximizing expected utility. This optimization task poses difficulties due to a high-dimensional discrete design space and, also, to an expected utility formula of high complexity. A simulation-based optimal design method is feasible in this case. In addition, two deterministic algorithms that perform a systematic search over the design space are developed to address the computational issues.     

Institutionalization of Life-Cycle Thinking in the Everyday Discourse of Market Actors

The widespread popularity of life-cycle assessment (LCA) is difficult to understand from the point of view of instrumental decision making by economic agents. Ehrenfeld has argued, in a 1997 issue of this journal, that it is the world-shaping potential of LCA that is more important than its use as a decision-making tool. The present study attempts to explore the institutionalization of this "LCA world view" among ordinary market actors. This is important because environmental policy relies increasingly on market-based initiatives. Cognitive and normative assumptions in authoritative LCA documents are examined as empirical data and compared with data from focus group interviews concerning products and the environment with "ordinary" manufacturers, retailers, and consumers in Finland. These assumptions are (1) the "cradle-to-grave" approach, (2) the view that all products have an environmental impact and can be improved, (3) the relativity of environmental merit, and (4) the way responsibility for environmental burdens is attributed. Relevant affinities, but also differences, are identified. It is argued that life-cycle thinking is not primarily instrumental, but rather is gaining a degree of intrinsic value. The study attempts to establish a broader institutional context in which the popularity of LCA can be understood. From the point of view of this broader context, some future challenges for the development of LCA and life-cycle thinking are suggested.     

Characterization of a xylanase from the newly isolated thermophilic Thermomyces lanuginosus CAU44 and its application in bread making

AIMS: A xylanase from the newly isolated thermophilic fungus, Thermomyces lanuginosus CAU44, was characterized and evaluated for its suitability in bread making. METHODS AND RESULTS: Xylanase was purified 3.5-fold to homogeneity with a recovery yield of 32.8%. It appeared as a single protein band on SDS-PAGE gel with a molecular mass of c. 25.6 kDa. The purified xylanase had an optimum pH of 6.2, and it was stable over pH 5.6-10.3. The optimal temperature of xylanase was 75 degrees C and it was stable up to 65 degrees C at pH 6.2. Study was further carried out to investigate the effect of the purified xylanase on the properties of wheat bread and its staling during storage. CONCLUSIONS: The purified xylanase from T. lanuginosus CAU44 was stable up to 65 degrees C and had a broad pH range. The presence of thermostable xylanase during bread making led to an improvement of the specific bread volume and better crumb texture. Besides, addition of xylanase provided an anti-staling effect. SIGNIFICANCE AND IMPACT OF THE STUDY: The xylanase from the newly isolated Thermomyces lanuginosus CAU44 shows great promise as a processing aid in the bread-making industry.     

Claiming respectable American motherhood: homebirth mothers, medical officials, and the state

Based on ethnographic research regarding public policy and grassroots organizing for midwifery in Virginia, this article explores how medical discourses around appropriate health care practices intersect with state discourses about what practices are considered "respectable" versus "pathological" for its citizens. In recent legislative debates about the legalization of direct-entry midwifery, medical officials have extended their criticism of midwifery and homebirth to mothers who resist state-sanctioned childbirth practices. This article examines how medical officials challenge the respectable mothering practices of homebirthers by linking them with women they deem pathological--child abusers, negligent mothers, and drug users--and placing them outside the cadre of "normal" American mothers who acknowledge the "logical" and "natural" superiority of biomedical childbirth practices. I also address homebirth mothers' responses, which assert that their political advocacy for midwives is a respectable mothering practice because they are responsible citizens who desire what they deem the best care for their children.     

胸部双源性疾病外科治疗的临床决策

胸部双源性疾病随人口的老龄化而逐年增加,而老年人的心肺及各种脏器功能随年龄的增长逐渐衰退,并发症多,手术风险大,对此类病人的外科治疗如何做出正确的临床医疗决策呢？我们以循证医学理论为基础,努力做到临床医疗决策的科学性,治疗方案的合理性,大胆尝试,逐步从分期手术向一期手术过渡,既达到了解决病人疾苦,救治病人的目的,又解决了医疗需求的增加和卫生资源短缺的矛盾,取得了满意的效果,降低了医疗成本,节约了医疗资源,产生了明显的社会和经济效益。     

贵州九香虫营养成分分析

分析贵州产九香虫Aspongopus chinensis Dallas体内的营养成分。结果表明:从江和习水产九香虫都具有丰富的营养,其中粗蛋白分别为350.9mg·g-1和356.5mg·g-1、粗脂肪432.6mg·g-1和436.2mg·g-1、粗灰分22.9mg·g-1和22.8mg·g-1;总氨基酸含量为334.3mg·g-1和253mg·g-1,其中必需氨基酸占总氨基酸的41.22%和33.34%,必需氨基酸与非必需氨基酸之比分别为0.70和0.50;九香虫体内脂肪酸多以油酸和软脂酸为主,其中油酸占总脂肪酸的49.48%和41.54%;含有丰富的矿物质和微量元素,尤其是Mg的含量达到1.26mg·g-1和1.32mg·g-1,且不含有对人体有害的Hg、Pb和As;含有多种维生素,其中维生素C含量最为丰富,为0.78mg·g-1和0.79mg·g-1。作为具有保健功能的中药昆虫,同时具有丰富的营养成分,九香虫是极具潜力的药食两用食品。