GIS技术支持下的陕西核桃精细化气候适宜性区划--测试文章

利用陕西96个气象站1981—2010年气象资料和地理信息数据,采用GIS技术对核桃种植进行气候适宜性区划。通过对陕西核桃生长的生态气候适宜性和陕西气候特点分析,选取年平均气温、年降水量、年日照时数、极端最低气温多年平均、日平均气温≥38℃日数5个因子作为陕西核桃种植气候适宜性区划指标,建立区划因子的小网格推算模型,在GIS技术的支持下完成其空间化,采用模糊综合评判的方法得到陕西核桃精细化气候适宜性区划图,并进行分区评述。研究结果表明：适宜区主要分布在北起陕北北部的安塞、子长、清涧、吴堡一线,南至陕南汉江河谷,除秦岭、陇山、黄龙山的深山外,陕北沟壑区、渭北塬区、关中平原和秦岭的浅山丘陵地区;渭北旱塬以北和秦岭北麓高海拔适宜区,应选种抗霜冻核桃品种,在避风向阳、半阳坡的坡地栽植;陕南秦巴山区适宜区应选种抗湿性好、抗病性强的核桃品种。     

空间流行病学分析中细小单元的区域化归并方法:以义乌市甲状腺癌为例

目的 空间流行病学研究中,细小地域单元由于人口数目少,偶发的个别病例出现就有可能导致极值的产生,给真实发病的分析带来困难。本研究以浙江省义乌市甲状腺癌2010-2013年监测数据和人口资料为基础,利用不同的区域划分描述甲状腺癌空间分布规律,探测病例空间聚集热点,为进一步开展环境和人群监测提供参考依据,同时评价小单元区域化在空间流行病学研究中的应用价值。方法 采用基于地理环境相似性(同质性检验)和空间相邻原则集群和分区的区域化方法,利用地理信息系统(GIS)将人口较少村落合并为具有足够人口基数的地理单元,以增加率值估计的稳定性和可靠性。结果 研究区新产生的区域单元具有足够的人口基数,产生的甲状腺癌发病率稳定和正态化。对新的区域单元进行热点探测(Getis-Ord)发现研究区中部平原地区有显著的高发病聚集。结论 小单元区域化方法能有效解决人口基数过小问题,有助于空间热点的探测与分析,能为进一步探寻甲状腺癌的危险因素提供依据。     

Homeoprotein hhex-induced conversion of intestinal to ventral pancreatic precursors results in the formation of giant pancreata in Xenopus embryos

Liver and ventral pancreas develop from neighboring territories within the endoderm of gastrulae. ventral pancreatic precursor 1 (vpp1) is a marker gene that is differentially expressed in a cell population within the dorsal endoderm in a pattern partially overlapping with that of hematopoietically expressed homeobox (hhex) during gastrulation. In tail bud embryos, vpp1 expression specifically demarcates two ventral pancreatic buds, whereas hhex expression is mainly restricted to the liver diverticulum. Ectopic expression of a critical dose of hhex led to a greatly enlarged vpp1-positive domain and, subsequently, to the formation of giant ventral pancreata, putatively by conversion of intestinal to ventral pancreatic precursor cells. Conversely, antisense morpholino oligonucleotide-mediated knockdown of hhex resulted in a down-regulation of vpp1 expression and a specific loss of the ventral pancreas. Furthermore, titration of hhex with a dexamethasone-inducible hhex-VP16GR fusion construct suggested that endogenous hhex activity during gastrulation is essential for the formation of ventral pancreatic progenitor cells. These observations suggest that, beyond its role in liver development, hhex controls specification of a vpp1-positive endodermal cell population during gastrulation that is required for the formation of the ventral pancreas.     

急诊临时输液室的责任分区管理

目的探讨急诊临时输液室中应用责任分区管理的效果。方法将输液室42个座位分3个区实施责任小组工作制,责任小组成员负责该区患者输液、观察与健康教育等,护士长或责任组长组织业务学习和进行质控。结果责任分区管理实施4个月来完成输液16 464例次,输液室铃声由以前每日1 000多次减少到100次左右,患者满意率由91.0%上升至98.3%,用药指导患者满意率达100%等。结论责任分区管理有利于提高护士的责任心和工作积极性,提高患者满意度。     

E MERGENT F IELD M EDICINE

Abstract

Objective. We sought to categorize and characterize the utilization of statewide emergency medical services (EMS) protocols as well as state recognition of specialty receiving facilities for trauma and time-sensitive conditions in the United States. Methods. A survey of all state EMS offices was conducted to determine which states use mandatory or model statewide EMS protocols and to characterize these protocols based on the process for authorizing such protocols. The survey also inquired as to which states formally recognize specialty receiving facilities for trauma, STEMI, stroke, cardiac arrest, and burn as well as whether or not states have mandatory or model statewide destination protocols for these specialty centers. Results. Thirty-eight states were found to have either mandatory or model statewide EMS protocols. Twenty-one states had mandatory statewide EMS protocols at either the basic life support (BLS) or advanced life support (ALS) level, and in 16 of these states, mandatory protocols covered both BLS and ALS levels of care. Seventeen states had model statewide protocols at either the BLS or ALS level, and in 14 of these states, the model protocols covered both BLS and ALS levels of care. Twenty states had separate protocols for the care of pediatric patients, while 18 states combined pediatric and adult care within the same protocols. When identified, the median age used to consider a patient for pediatric care was ≤14 years (range ≤8 to ≤17 years). Three states’ protocols used a child's height based on a length-based dosage tool as the threshold for identifying a pediatric patient for care using their pediatric protocols. States varied in recognition of receiving centers for EMS patients with special medical needs: 46 recognized trauma centers, 25 recognized burn centers, 22 recognized stroke centers, 11 recognized centers capable of percutaneous coronary intervention for ST-elevation myocardial infarction, and 3 recognized centers for patients surviving cardiac arrest. Conclusion. Statewide mandated EMS treatment protocols exist in 21 states, and optional model protocol guidelines are provided by 17 states. There is wide variation in the format and characteristics of these protocols and the recognition of specialty receiving centers for patients with time-sensitive illnesses.     

无菌物品区域化供应的管理方法与体会

目的探讨开展无菌物品区域化供应管理的方法与成效。方法优化区域化消毒供应中心配置,制订区域化供应工作流程和相关制度,对8所医院的无菌物品进行区域化管理及卫生消毒供应服务;在医院财务部门的共同协作下,完成对所有无菌物品的全成本核算。结果提高了无菌物品的清洗和包装质量（P〈0．01）;降低了消毒供应中心的运营成本（P〈0．01）。结论医院开展无菌物品区域化供应模式值得推广应用。     

A conceptual approach to improving care in pandemics and beyond: Severe lung injury centers

The events of the 2009 influenza pandemic sparked discussion regarding the need to optimize delivery of care to those most severely ill. We propose in this conceptual study that a tiered regionalization care system be instituted for patients with severe acute respiratory distress syndrome. Such system would be a component of national pandemic plans and could also be used in day-to-day operations.