示范区创建活动与社区卫生服务长效机制的建立和可持续发展对策的思考

通过第三方评估全国社区卫生服务示范区是我国社区卫生服务发展史上的一大创举。此项活动的开展,极大的提高了各地政府对发展社区卫生服务的思想认识、政策理解和经费投入力度。通过创建和评估活动,系统总结了各申报地区社区卫生服务的经验和特色,分析了存在的问题和不足,提出了发展社区卫生服务的对策和建议,制定了社区卫生服务可持续发展的长效机制,取得了预期效果,达到了预期目的。随着《国务院关于发展城市社区卫生服务的指导意见》的出台,示范区的典型示范效应会日益凸显出来,对我国社区卫生服务的发展将起到不可估量的作用。     

化学气相淀积过程中钛酸丁酯热解反应机理及动力学

利用热解-色质联用分析系统,对文题进行了研究,发现其热解过程是一个复杂的多元反应过程。在500～800℃,钛酸丁酯(Ⅰ)热解尾气产物主要是烯烃、醇、醚和醛类化合物。经热解机理分析,发现Ⅰ的重排断裂反应是整个热解过程的主反应,其反应动力学常数为3.87×10~5,活化能为69.3 kJ/     

Evidence for a reflex provoking contraction of the renal pelvis (with some comments on its clinical implications)

The effect of swallowing a small quantity of water or of solid food (biscuit) on the renogram curve was observed in 177 patients. Swallowing provoked contraction of the renal pelvis in 63% of the kidneys with a pelvicalyceal system which was neither obstructed nor dilated, with expulsion of a substantial fraction of the contents within 30 s. This did not occur in obstructed or denervated kidneys, nor in patients with a high transection of the spinal cord. Evidence is adduced that this contraction is mediated reflexly. This effect may be used diagnostically to distinguish physiological dilatation from obstruction. The implications when performing and interpreting renography are discussed. Correspondence to: M.V. Merrick     

Expanding Our Strategies to Study the Process of Change

The conceptual and methodological framework proposed by Doss (this issue) makes valuable suggestions for strategic choices in future research. This commentary addresses conceptual and terminological distinctions adopted by Doss, as well as his criticism of add-on/ dismantling studies. We also suggest research topics and methodological developments that could be integrated in Doss's framework to further expand understanding of therapeutic change.     

医院管理"四部曲"

结合医院管理实际,实施管理四部曲。即:完善机制、教育先行、督察到位、奖惩分明。阐明持续改进是完善机制的内在需求;及时清理是完善机制的有力保障;易于操作是完善机制的必备条件。同时,突出教育的基础性地位;强调监督的关键性环节;放大奖惩的激励性效应。     

丹霞地貌生境中铁皮石斛的繁殖生物学研究

目的:揭示丹霞地貌生境中铁皮石斛的繁育系统及濒危机制.方法:对该地区铁皮石斛的生境、生长特性、开花物候、繁殖特性以及资源破坏状况等进行了调查.结果:丹霞地貌铁皮石斛生长环境恶劣,春季为其生长高峰;2～3年生茎开花,花后及时授粉,结实率较高;授粉后4～5 d子房开始膨大,果实成熟期为185 d左右;自然有性繁殖的结实率(0.31%)极低;无性克隆繁殖1丛仅1年生1茎.结论:丹霞地貌生境下铁皮石斛群体自然更新主要是通过分蘖繁殖实现的;人为掠夺性采集是该地区铁皮石斛野生资源濒危的主要因素.     

Controlled Release of Substituted Benzole and Naphthoic Acids Using Carbopol ® Gels: Measurement of Drug Concentration Profiles and Correlation to Release Rate Kinetics

Purpose. The objective of this study is to correlate drug release mechanism with measured drug concentration profiles in gel layers of Carbopol^® matrices containing mesalamine or benzoic acid. Methods. Release rate experiments with Carbopol^® matrices were performed using a rotating disk apparatus. Matrices were frozen and the gel layer in the matrices was sliced using a microtome in a cryostat. Drug concentration profiles were determined by direct measurement of the concentration of the drug in the gel slices. The pH of the slices was measured using microelectrodes, and water content was measured by Karl Fisher titration. Results. The concentration gradient in mesalamine matrices decreased over time and correlated with square root of time release rate kinetics. The concentration profiles of benzoic acid were unchanged over time and correlated with zero order release rate kinetics. Carbopol gel layers were highly hydrated (93–95% water). Gel layers in matrices with mesalamine had a more alkaline microenvironmental pH. This higher pH resulted in increased growth of the thickness of the gel layer and a reduction drug diffusivity in comparison to benzoic acid matrices. Conclusions. The release rate kinetics of mesalamine and benzoic acid correlated to the measured concentration profiles. The shape of the concentration profiles is determined by the rate of growth of the Carbopol^® gel layer and drug diffusivity.     

Muscle spasm induced sympathetic reflex bursts on microneurography in a case with pontine demyelination

Microneurography was performed in a 39-year-old woman with demyelination of the pontine white matter associated with muscle spasms in the lower extremities. Single bursts on the microneurogram were observed immediately after cessation of the spasm with no systemic changes in the blood pressure or heart rate. Voluntary tonic flexion of the lower extremities induced similar bursts with small amplitudes. These reflex bursts possessed a characteristic of muscle sympathetic nerve activity, because the latency between the peak of each burst and the prior R-wave on the electrocardiograph was constant. The occurrence of these bursts suggests that a segmental compensatory mechanism in the spinal cord may stabilize the muscle blood flow influenced by muscle contraction.     

关于军工研究所发展民品产业的几点思考

探索军工研究所发展民品产业之路.本文对军工研究所发展民品产业进行了优劣势分析,继而从机制转换,组织结构,产品战略,市场营销,人才队伍建设等方面提出了一些改革措施.     

实施绩效考核的实践和体会

介绍绍兴市人民医院实施绩效考核的经验和体会.其经验在于:明确考核定位,把考核的首要目的定位于医院管理目标的实现和对管理过程的一种控制;运作方式是:制定考核标准、确立考核周期、明确考核部门及人员,使绩效考核真正落到了实处,收到了显著效果.