糖尿病患者心理健康状况的多因素Logistic回归分析

目的探讨糖尿病患者心理健康状况的影响因素。方法对山西省4个地区8个调查点的2132名城乡居民，其中包括139名糖尿病患者，进行问卷调查，了解其一般情况以及情绪状况、社会支持等社会心理因素。结果单因素分析发现，糖尿病患者的焦虑情绪高于非糖尿病者，对社会支持中的家庭资源的利用也不及非糖尿病者；多因素发现，影响糖尿病患者心理健康状况的因素有地区、性别、年龄、经济收入、焦虑以及抑郁等；结论糖尿病患者心理健康状况的影响因素既涉及地区、性别、年龄、经济收入等一般状况，也与患者的情绪障碍的社会支持有密切关系。临床应根据不同的影响因素进行有效牙心理干预。     

A组轮状病毒广州地方株VP7基因序列的比较分析

目的 了解我国轮状病毒G1型广州地方株与标准株及北京G1型地方株VP7基因序列的差异，为我国轮状病毒疫苗的研制提供资料。方法 通过逆转录—聚合酶链反应(RT—PCR)获得了轮状病毒广州地方株R97—196 VP7全基因的cDNA片段，将其克隆入T—A克隆质粒pUCm—T中，构建成重组质粒pUCmT—VP7，对克隆的VP7基因进行序列测定。结果 该地方株的基因核苷酸全长为1062nt，读码框架和以往的研究一致，和北京G1型地方株173的VP7氨基酸序列具有高度同源性(98％)，而与不同血清型标准株间则变异较大(73％—81％)，氨基酸序列中存在的一些高变区和保守功能区与已报道的研究结果一致。从进化角度分析，与轮状病毒标准株Wa株，相距较远。结论 轮状病毒广州地方株R97—196 VP7基因片段属G1型，轮状病毒VP7基因的变异与地域有一定关系。     

Analyzing Event-Related Potentials: The Utility of High and Low Pass Filtering in Improving the Relationship Between Various Amplitude Measures and Principal Components Analysis Factor Scores

The present investigation sought to determine whether the relationship between event-related potential (ERP) principal components analysis (PCA) factor scores and analogous waveform amplitude measures could be improved by high- and low-pass filtering the waveforms at a suitable cutoff value. Visual oddball ERPs were submitted to a varimax-rotated PCA performed on the variance/covariance matrix. Principal components corresponding to P300 and Slow Wave were obtained. In keeping with the fact that the variance/covariance PCA analyzes sources of variance around the grand mean waveform, the grand mean waveform was subtracted from each of the original waveforms, and baseline-referenced amplitude measurements were then made of P300 and Slow Wave. P300 was measured both as the maximum positive peak between 275 and 425 ms, and as the average amplitude during that interval. Slow Wave was measured as the average amplitude during the interval 400–700 ms. The P300 measurements were then repeated after high-pass filtering the difference waveforms at 2 Hz. Slow Wave measurements were repeated after low-pass filtering at 2 Hz. The value of 2 Hz was chosen as giving a reasonable cutoff based upon estimates of the wavelengths of the two components derived from inspection of their respective factor loading vectors. The correlation between factor scores and amplitude measurements was .94 for unfiltered Slow Wave and actually declined slightly but significantly to .91 when the waveforms were low-pass filtered. It would appear that Slow Wave factor scores emerging from a PCA can be fairly well approximated by a time-band measurement algorithm, and that this approximation is not improved by low-pass filtering. For both filtered and unfiltered measurements of P300, the amplitude/factor score correlation was significantly higher for the time-band method than for the peak method. Further, high-pass filtering at 2 Hz improved the time-band/factor score correlation significantly from .62 to .75. This improvement is probably because the unfiltered measurements were tapping sources of variance due both to the higher frequency P300 component as well as a simultaneously active, lower frequency Slow Wave component. Theoretical implications of these findings are discussed.     

Analysis of fMRI data by blind separation of data in a tiny spatial domain into independent temporal component

Independent Component Analysis (ICA) is a promising tool for the analysis of functional magnetic resonance imaging (fMRI) time series. In these studies, mostly assumed is a spatially independent component map of fMRI data (spatial ICA). In this paper, we assume that the temporal courses of the signal and noises are independent within a Tiny spatial domain (temporal ICA). Then with fast-ICA algorithm, spatially neighboring fMRI data were blindly separated into several temporal courses and were preassumed to be formed by a signal time course and several noise time courses where the signal has the largest correlation coefficient with the reference signal. The final functional imaging was completed for the signals obtained from each voxel. Simulations showed that compared with the spatial ICA method, the new temporal ICA method is more effective than the spatial ICA in detecting weak signal in a fMRI dataset. As background noise, the simulations include simulated Gaussian noise and fMRI data without stimulation. Finally, vivo fMRI tests showed that the excited areas evoked by a visual stimuli are mainly in the region of the primary visual cortex and that evoked by auditory stimuli are mainly in the region of the primary temporal cortex.     

类金刚石薄膜的碳相成分对其血小板黏附特性的影响

对不同工艺和条件制备的 7个类金刚石薄膜 (Diamondlikecarbon ,DLC)试样 ,经X光电子能谱 (XPS)碳相成分分析后 ,分别进行了血小板黏附实验、黏附血小板的形貌观察、分类计数和形态指数计算 ,并通过灰色关联分析 ,研究了碳相成分对血小板黏附量、黏附血小板的形态指数的影响。结果显示 :来自全方位离子注入离子束增强沉积工艺的DLC ,其血小板黏附量和形态指数明显小于等离子体化学气相沉积工艺制备的样品 ;在DLC的 5种碳相成分中 ,DLC碳相与血小板黏附量和形态指数的 (负 )关联度远大于其它碳相成分 ,除此之外只有C H和C O碳相与血小板形态指数的 (正 )关联度较大。表明 :(1)DLC碳相对血小板黏附的影响远较其它碳相成分为大 ,增加DLC碳相的含量是优化DLC血液相容性的关键所在 ;(2 )C H和C O碳相对黏附血小板的变形有促进作用 ,须从工艺上抑制其产生或尽可能降低其含量 ;(3)采用全方位离子注入离子束增强沉积工艺有助于改善DLC的血液相容性。这些结论对设计与改进DLC的制备工艺具有重要的指导意义。     

The role of surgery in transmitting ≪ post-transfusion hepatitis ≫

The role of surgery as an additional risk in transmitting post-transfusion hepatitis was investigated in a retrospective study on acute hepatitis occurring in 77 transfused patients, 293 transfused and operated patients and 243 hepatitis cases with history of surgery without transfusion.Hepatitis A patients admitted to the same centres in the same period were utilized as controls. In transfused patients the percentage of NANB hepatitis was higher than that of type B (61.0% vs. 36.4%), while in the operated not transfused group the percentage of type B was twice that of type NANB (63.4% vs. 32.5%).In transfused and operated cases intermediate values were observed. The age-adjusted measures of association between exposures and the different hepatitis types showed a lack of effect of transfusion and a dominant role of surgery in transmitting type B hepatitis. In contrast, NANB post-transfusional cases were actually a mixture of post-transfusional and post-surgical cases, since both these exposures were found to be significantly associated with the disease.Our results suggest that studies on the incidence and the etiology of post-transfusion hepatitis should take into account the risk of surgical exposure which might have occurred.Corresponding author.     

病例组合指数的内涵及应用探讨

国内普遍认为病例组合指数(CMI)属于医疗服务能力维度,体现收治疾病的疑难复杂程度和医疗服务的整体技术难度。通过结构方程模型分析发现,CMI与时间消耗指数、费用消耗指数等服务效率维度指标联系更紧密,与DRG组数、入组病例数及总权重等服务能力维度指标联系相对较弱,故应归属医疗服务效率维度。CMI的直接应用主要是对平均住院费用的预测控制及对科室绩效的评价;CMI的间接应用主要是对管理指标的调整/校正。医院管理者应准确把握CMI内涵,恰当应用CMI对不同层级及不同类别住院费用进行预测、评价与控制,并对其他管理指标进行调整后再评价。     

医院绩效管理政策文本量化分析

目的对中央政府层面出台的公立医院绩效管理相关政策文件进行分析,为优化政策体系提供参考。方法访问北大法宝网、国务院及相关部委官方网站,检索2009年1月1日-2021年7月21 日医院绩效管理相关政策文件,基于政策工具理论,构建医院绩效管理政策工具分析框架,采用内容分析法对政策文本进行量化分析。结果共纳入政策文件31份,归纳整理出供给型、需求型和环境型3个类别 22 种政策工具。供给型政策工具占 43.40%,需求型政策工具占 19.25%,环境型政策工具占 37.35%。政策条款频数较高的分别是“分级诊疗”“目标规划”及“收入分配”。结论政策工具要注重结构均衡性,坚持以人民健康为目标导向,强化需求方对医院绩效的影响力;关注医院绩效考核,促进区域医疗服务能力提升;强化政策执行力度,充分发挥政策叠加效应。     

患者知情同意权代为行使的案例分析及启示

以医疗典型纠纷案例为例,通过厘清相关法律对患者知情同意权行使及代为行使的相关规定,探讨知情同意权代为行使行为的界定。启示如下:知情同意权代为行使应设前置条件进行限制和约束;代为行使主体包括近亲属或关系人、委托代理人;患者本人意见具有首要优先性,委托代理人意见应优先于近亲属意见。     

34家医院医保精细化管理案例的定性比较

目的探究实现我国医院医保精细化管理的不同路径。方法采用模糊集定性比较分析方法（fsQCA）对34家医院医保精细化管理案例进行组态分析。结果路径一:组织建设+制度建设+创新模式建设（边缘条件）;路径二:制度建设+创新模式建设;路径三:组织建设+信息化建设;路径四:信息化建设+创新模式建设。结论我国医院医保精细化管理实现路径可分为传统驱动型、创新技术驱动型和综合驱动型3种模式。医院可多元性选择,进一步探索医保精细化管理的现实路径。