公立医院开展突发公共事件医疗应急救援的SWOT分析

采用SWOT分析方法对新形势下我国公立医院开展突发公共事件医疗应急救援工作的优势、劣势、机会与威胁进行系统分析,并提出我国公立医院开展突发公共事件医疗应急救援工作的发展策略,为更好地开展相关工作提供参考。     

A joint frailty model for survival and gap times between recurrent events

Therapy for patients with a recurrent disease focuses on delaying disease recurrence and prolonging survival. A common analysis approach for such data is to estimate the distribution of disease-free survival, that is, the time to the first disease recurrence or death, whichever happens first. However, treating death similarly as disease recurrence may give misleading results. Also considering only the first recurrence and ignoring subsequent ones can result in loss of statistical power. We use a joint frailty model to simultaneously analyze disease recurrences and survival. Separate parameters for disease recurrence and survival are used in the joint model to distinguish treatment effects on these two types of events. The correlation between disease recurrences and survival is taken into account by a shared frailty. The effect of disease recurrence on survival can also be estimated by this model. The EM algorithm is used to fit the model, with Markov chain Monte Carlo simulations in the E-steps. The method is evaluated by simulation studies and illustrated through a study of patients with heart failure. Sensitivity analysis for the parametric assumption of the frailty distribution is assessed by simulations.     

Alternative operation models for using a feed‐in terminal as a part of the forest chip supply system for a CHP plant

The fuel supply of forest chips has to adapt to the annual fluctuations of power and heat generation. This creates inefficiency and unbalances the capacity utilization of the fuel supply fleet in the direct fuel supplies from roadside storages to power and heat generation. Terminals can offer an alternative approach for the fleet management of fuel supplies in terms of smoothing the unbalanced fleet use towards more even year‐round operations. The aim of the study was to compare the supply costs of a conventional direct forest chip supply to an alternative fuel supply with the use of a feed‐in terminal using the discrete‐event simulation method. The influences of the terminal location, terminal investment cost, outbound terminal transport method, terminal truck utilization and quality changes of terminal‐stored forest chips for the fuel supply cost were studied in the case environment. By introducing a feed‐in terminal and a shuttle truck for the transports of terminal‐stored forest chips, the total supply cost was 1.4% higher than the direct fuel supply scenario. In terminal scenarios, the supply costs increased 1–2% if the cost of the terminal investment increased 30%, the distance to the terminal increased from 5 to 30 km or the total annual use of a terminal truck decreased 1500 h. Moreover, a 1 per cent point per month increase in the dry matter loss of terminal‐stored chips increased the total supply cost 1%. The study revealed that with the relatively low additional cost, the feed‐in terminal can be introduced to the conventional forest chip supply. Cost compensation can be gained through the higher annual use of a fuel supply fleet and more secured fuel supply to power plants by decreasing the need for supplement fuel, which can be more expensive at a time of the highest fuel demand.     

Silurian carbonate platforms and extinction events—ecosystem changes exemplified from Gotland, Sweden

Recent and ancient carbonate platforms are major marine ecosystems, built by various carbonate-secreting organisms with different sensitivity for environmental change. For this reason, carbonate platforms are excellent sensors for changes in contemporaneous marine environments. A variety of ecosystem changes in carbonate platforms have previously been recognised in the aftermath of mass extinction events. This paper addresses how two Silurian extinction events among graptolites, conodonts, and pentamerid brachiopods can be related to changes in the style of carbonate production and general evolution of low latitude carbonate platforms in a similar way as previously reported from the major five mass extinctions of the Phanerozoic. Strata formed on Gotland during the Mulde and Lau events share remarkably many similarities but are strikingly different in composition compared to other strata on the island. The event-related strata is characterised by the sudden appearance of widespread oolites, deviating reef composition, flat-pebble conglomerates, abundant micro- and macro-oncoids, stromatolites, and other microbial facies suggesting decreased bioturbation levels in contemporaneous shelf seas. Importantly, these changes can be tied to high-resolution biostratigraphic frameworks and global stable isotope excursions. The anomalous intervals may therefore be searched for elsewhere in order to test their regional or global significance.     

Preattentive auditory information processing under exposure to the 902 MHz GSM mobile phone electromagnetic field: A mismatch negativity (MMN) study

Previous studies on the effects of the mobile phone electromagnetic field (EMF) on various event‐related potential (ERP) components have yielded inconsistent and even contradictory results, and often failed in replication. The mismatch negativity (MMN) is an auditory ERP component elicited by infrequent (deviant) stimuli differing in some physical features from the repetitive frequent (standard) stimuli in a sound sequence. The MMN provides a sensitive measure for cortical auditory stimulus feature discrimination, regardless of attention and other contaminating factors. In this study, MMN responses to duration, intensity, frequency, and gap changes were recorded in healthy young adults (n = 17), using a multifeature paradigm including several types of auditory change in the same stimulus sequence, while a GSM mobile phone was placed on either ear with the EMF (902 MHz pulsed at 217 Hz; SAR_1g = 1.14 W/kg, SAR_10g = 0.82 W/kg, peak value = 1.21 W/kg, measured with an SAM phantom) on or off. An MMN was elicited by all deviant types, while its amplitude and latency showed no significant differences due to EMF exposure for any deviant types. In the present study, we found no conclusive evidence that acute exposure to GSM mobile phone EMF affects cortical auditory change detection processing reflected by the MMN. Bioelectromagnetics 30:241–248, 2009. © 2009 Wiley‐Liss, Inc.     

末次冰期以来中国海区浮游有孔虫Pulleniatina obliquiloculata含量变化的地层学意义

西北太平洋尤其是中国海区末次冰期旋回中浮游有孔虫Pulleniatina obliquiloculata含量变化研究是近年来最重要的古海洋学内容之一.作者综合分析了中国及邻近海区具有可靠测年地层的深海沉积物柱状样中P.obliquiloculata含量变化,探讨其含量低值事件(PME)的生物地层学意义.末次冰期以来P.obliquiloculata含量变化在中国海区呈现两种变化模式:一是以东海及南海北部为代表的冰期含量低、间冰期含量高的特点;另一种则是南海南部的冰期含量高、间冰期含量低的现象.高分辨率地层记录显示,在这种冰期/间冰期总体变化趋势基础上,我国东海、南海和黑潮源区等广泛存在晚全新世～4 300-2 800 cal yr BP P.obliquiloculata含量低值,但以南海北部与东海冲绳海槽最为明显;而南海南部P.obliquiloculata含量还在冰消期(～16.5-15 cal kyr BP)有另一特征的低含量阶段.因而,末次冰期旋回中国海区P.obliquiloculata含量变化可以作为区域性地层划分和对比的标志.尽管如此,由于黑潮分支水团的影响,冲绳海槽中部和北部部分海域,在末次冰期与PME期间,P.obliquiloculata虽然含量相对较低,但仍可保持3%-5%以上,而非多数站位PME事件中的特征性零含量.研究表明PME事件主要由次表层海水的温度降低、温跃层变浅、上部水体温度梯度增加等引起,与表层海水无关,但引起这些海洋环境变化的原因尚不清楚.     

Smoothing spline ANOVA frailty model for recurrent event data

Gap time hazard estimation is of particular interest in recurrent event data. This article proposes a fully nonparametric approach for estimating the gap time hazard. Smoothing spline analysis of variance (ANOVA) decompositions are used to model the log gap time hazard as a joint function of gap time and covariates, and general frailty is introduced to account for between-subject heterogeneity and within-subject correlation. We estimate the nonparametric gap time hazard function and parameters in the frailty distribution using a combination of the Newton-Raphson procedure, the stochastic approximation algorithm (SAA), and the Markov chain Monte Carlo (MCMC) method. The convergence of the algorithm is guaranteed by decreasing the step size of parameter update and/or increasing the MCMC sample size along iterations. Model selection procedure is also developed to identify negligible components in a functional ANOVA decomposition of the log gap time hazard. We evaluate the proposed methods with simulation studies and illustrate its use through the analysis of bladder tumor data.