Bayesian adaptive survey protocols for resource management

Transparency in resource management decisions requires a proper accounting of uncertainty at multiple stages of the decision-making process. As information becomes available, periodic review and updating of resource management protocols reduces uncertainty and improves management decisions. One of the most basic steps to mitigating anthropogenic effects on populations is determining if a population of a species occurs in an area that will be affected by human activity. Species are rarely detected with certainty, however, and falsely declaring a species absent can cause improper conservation decisions or even extirpation of populations. We propose a method to design survey protocols for imperfectly detected species that accounts for multiple sources of uncertainty in the detection process, is capable of quantitatively incorporating expert opinion into the decision-making process, allows periodic updates to the protocol, and permits resource managers to weigh the severity of consequences if the species is falsely declared absent. We developed our method using the giant gartersnake (Thamnophis gigas), a threatened species precinctive to the Central Valley of California, as a case study. Survey date was negatively related to the probability of detecting the giant gartersnake, and water temperature was positively related to the probability of detecting the giant gartersnake at a sampled location. Reporting sampling effort, timing and duration of surveys, and water temperatures would allow resource managers to evaluate the probability that the giant gartersnake occurs at sampled sites where it is not detected. This information would also allow periodic updates and quantitative evaluation of changes to the giant gartersnake survey protocol. Because it naturally allows multiple sources of information and is predicated upon the idea of updating information, Bayesian analysis is well-suited to solving the problem of developing efficient sampling protocols for species of conservation concern. © 2011 The Wildlife Society.     

Technological and molecular diversity of Lactobacillus plantarum strains isolated from naturally fermented sourdoughs

Thirty Lactobacillus (L.) plantarum strains, isolated from sourdough, were identified by biochemical tests as well as 16S rDNA sequencing and differentiated on the basis of technological properties, such as amylase, protease, phytase and antirope activities. These properties were shown to be widely differing among the strains, indicating a significant technological diversity. Genetic differentiation was achieved by restriction endonuclease analysis-pulsed field gel electrophoresis (REA-PFGE) that allowed the L. plantarum strains to be divided into 10 different genomic groups. Moreover, 32 different starters were employed in dough making experiments; each starter consisted of a single strain of L. plantarum associated with a maltose positive or a maltose negative yeast. The technological properties of the doughs were greatly influenced by the type of strain included in the starter. The time of leavening and the acidification activities detected in the dough were enhanced by the presence of L. plantarum strains. The bacterial and yeast contents and fermentation properties were statistically treated by principal component analysis (PCA), which allowed the discrimination of different typologies of dough. The study of the peculiar characteristics of different strains of L. plantarum is fundamental for a better understanding of their potential in affecting the nutritional value, quality and stability of the baked goods. L. plantarum strains are able to differentially influence the dough quality when employed as starters.     

临床生物化学与检验教育史话

临床生物化学与检验是在对人体正常、病理状况的生理生化变化过程认识的基础上,通过分析人体标本为疾病的诊断和治疗提供有用的信息。其课程主要内容包括糖类、脂类、核酸、蛋白质、酶、激素、有机小分子、血液气体、电解质、治疗性药物、临床毒物等的检测及其临床应用。临床生物化学与检验课程对临床医学和医学检验专业学生非常重要。本文对临床生物化学与检验课程建设的历史和现状进行了总结。     

“先看病后付费”医疗服务改革效果调查与分析

目的 比较济宁市各级各类医疗机构的医疗服务、质量、效率、费用等关键要素变化,为完善“先看病后付费”诊疗服务模式提供参考依据。方法 选取济宁市266家各级各类医疗机构为调查对象,采用自行设计的“济宁市‘先看病后付费’工作推广效果评估调查表”进行问卷调查,同时分层抽样15家医院进行现场访谈。结果 济宁市享受“先看病后付费”住院患者惠及率达到59.45%,年增加37.29%;全市各级各类医疗机构全面实施了此项制度,二级及以下医疗机构惠及率高于三级医疗机构,分别达到77.18%、63.71%。结论 “先看病后付费”服务模式改革,满足了群众医疗需求,医保（新农合）住院患者总费用得到合理控制,患者自付就医经济负担进一步减轻。为规避风险,提出解决垫付资金和恶意欠费问题解决方案。     

利益相关主体医疗风险分担机制的探讨

随着科技的快速发展和信息的扁平化,人类社会的各种风险在不断扩大,个体承担风险的程度是有限的,利益相关主体的合理化分担是保证风险化解的基础。医学作为一门不精确的科学,接近真理和无法穷尽真理是客观事实,作为探索医学真理的利益相关主体的患者、医疗工作者、医院和政府,单一分担医疗风险是不合理的,只有按照相关的规则共同分担,才能保证医学科学的进步和发展。     

医疗授权管理在综合性医院的应用与探讨

为保障医疗质量和医疗安全,制定《医疗授权管理制度》,通过对医疗小组组长、住院总医师等岗位进行授权,实施医疗准入、追踪和全过程管理,落实执业人员岗位责任制,进一步规范医师执业行为,确保临床医疗技术合理应用。同时,建立完整的考核评价体系与退出机制,与绩效挂钩,充分调动被授权者的积极性。     

9所大学附属医院职业化管理认知及培训需求分析

目的 调查并分析某医科大学9所附属医院职能部门工作人员对管理人员职业化的认知和培训需求。方法 采用整群抽样法,向9所附属医院的职能部门工作人员发放调查问卷,调查内容包括个人基本情况、工作情况、培训情况等五部分内容,共发放799份问卷,回收799份问卷,回收率100%。结果 9所附属医院职能部门工作人员中,有78.7%对未来职业发展有信心,21.0%认为目前的医院管理职业化建设不完善,57.5%认为医院中高层管理者应该来源于卫生管理专业人员,59.4%认为培训次数不够,60.4%认为迫切需要进行管理知识培训。结论 大多数医院管理人员对未来职业化发展有信心,但是目前医院管理知识培训存在不足,建议大学与附属医院合作开展系统的个性化的医院管理知识培训,提高医院管理水平,促进管理队伍职业化发展。     

国外继续教育模式对我国继续医学教育的启示

分析国外先进继续教育模式,总结我国继续教育存在的问题和困难,主要包括：法律法规不健全、形式相对单一、培养模式普教化、市场运行机制尚未健全、实践教学相对薄弱、师资队伍建设滞后。借鉴国外经验提出几点启示：健全医学继续教育法律法规及监控体系、加强校企合作、完善市场机制、加强实践教学、完善评估体系。     

山西省医疗机构服务能力分析与评估系统开发与应用

介绍了山西省医疗机构服务能力分析与评估系统开发的必要性,描述了具体的系统设计方案、运行流程、分析方法及应用情况。通过该系统的应用,及时收集全省二级以上医疗机构病案首页数据、门诊患者的诊疗数据与医疗机构经济运行数据,及时分析评估医疗机构的医疗技术服务能力、医疗质量、管理水平、患者费用负担、经济运行状况以及影响全省人群的主要疾病等指标,为卫生行政部门实施医疗卫生体制改革、医疗机构日常监管、全省范围内疾病防控等提供数据支持。