一种心电数据压缩算法的研究

利用心电信号的相关性，对ECG进行预处理，再进行差值运算，将得到的差值序列进行DCT变换，从而实现心电数据的压缩。     

Phasic Heart Rate Change and the U-Shaped Relationship Between Choice Reaction Time and Auditory Signal Intensity

The effect of auditory intensity on choice reaction time (RT) and heart rate (HR) was studied in two experiments using a 2.5-sec fixed foreperiod paradigm and a mixed block intensity presentation mode. Experiment I showed a U-shaped RT/intensity function and a triphasic HR response. However, the usually obtained anticipatory HR deceleration did not appear. There was only a slight deceleration after the onset of the imperative signal. Both strong tones and faster responding were associated with a more rapid shift from less deceleration to more acceleratory recovery. A second experiment produced similar findings. In addition, differential warning with respect to signal intensity reduced its effect on RT and accelerated the HR response to the imperative signal. The triphasic HR response disappeared in reaction to a “No-Go” warning signal instructing the subject to withhold his motor response to the imperative signal. It was argued that, apart from being an input variable, auditory intensity has an additional effect upon the motor system. It was concluded that this immediate arousal effect of loud auditory signals (Sanders, 1977) could be related to Graham's (1980) notion of defense as primarily a motor facilitating system. Finally, the finding of a consistent relationship between fast reactions and less deceleration together with the absence of the anticipatory deceleration clearly does not fit either the Obrist model or the Lacey model.     

北京市16区患者基层医疗卫生机构就诊情况及影响因素研究

背景　近年来北京市分级诊疗服务体系已初现雏形,其中基层首诊作为分级诊疗的基础,对提高医疗服务体系运行效率十分重要。患者作为医疗服务的需方,研究其就医选择意愿及影响因素对落实基层首诊具有重要意义。目的　了解北京市患者在“生小病”时的就医选择及影响因素,从而为将患者引流至基层提出针对性建议。方法　于2019年5月在北京市16个区的48家区属二、三级医院中采用方便抽样的方式对门诊和住院患者的基层就诊选择意愿及其个人基本信息、健康状况和政策知晓情况进行调查。采用多因素Logistic逐步回归分析患者“生小病”时选择基层医疗卫生机构的影响因素。结果　共有3 732例调查对象纳入本研究,其中1 541例（41.29%）患有慢性病;知晓北京开展家庭医生制度和分级诊疗制度的患者分别为1 509例（40.43%）、1 641例（43.97%）,但签约了家庭医生的患者仅占12.43%（464/3 732）。1 349例（36.15%）调查对象“生小病”时会选择前往基层医疗卫生机构就医。多因素Logistic逐步回归分析结果显示,户籍、年龄、文化程度、社会医疗保险情况、家庭月收入、健康自评情况、慢性病数量、家庭医生制度知晓情况、家庭医生签约情况及分级诊疗制度知晓情况是调查对象就诊机构选择的影响因素（P<0.05）。结论　老年人、北京市户籍人口、有社会医疗保险、文化程度和收入较低、知晓分级诊疗和家庭医生相关政策、签约了家庭医生的患者在“生小病”时更倾向选择基层医疗卫生机构,因此对于非北京户籍、无社会医疗保险患者人群,应努力提高医疗保障,加强健康宣教;同时提高基层医疗技术水平和就诊环境,加大医改政策的宣传力度,并继续扩大家庭医生签约覆盖率,吸引更多患者下沉基层。     

十二指肠损伤的诊断与术式选择

目的：探讨十二指肠损伤的诊断与术式选择。方法：回顾分析37例十二指肠损伤的临床资料。结果：术前确诊4例，术中确诊31例，漏诊2例。行十二指肠修补或吻合（包括空肠十二指肠Roux-en-Y吻合6例）加胃造瘘或胃空肠双管造瘘术36例（97.3%)；胰十二指肠切除术1例（2.7%)。治愈36例（97.3%)，死亡1例（2.7%)。结论：修补或吻合加双管造瘘法是治疗十二指肠损伤的一种易于掌握，操作简单，符合生理要求，并发症也少的术式。     

Organ and tissue donation: a trustwide perspective or critical care concern?

Organ donation has become an accepted practice within the critical care setting; however, tissue donation is seldom considered within the ICU environment and even less in other hospital departments. This study describes the results from an early base line audit performed as the first stage in a larger action research project following the implementation of the Donor Liaison Scheme in an NHS trust. It was designed to assess the current level of knowledge, confidence and value system staff have, working in all areas of the hospital setting in relation to organ and tissue donation. The results from this audit highlight key areas for practice development across all areas of this NHS trust. Many healthcare professionals working within this trust are unaware that donation can be considered. The respondents identified a lack of knowledge and confidence to be able to identify and discuss the options of donation with a family, yet the majority believe strongly that a person's wishes should be respected after death. People who have signed on the NHS ODR anticipate that healthcare professionals will access the ODR and support their family in following through their wishes; therefore, all healthcare professionals should receive education on donation issues as an integral part of bereavement and end of life decision training. Education strategies that adopt an experiential approach should be developed in order to create confidence in healthcare professionals to offer choice in donation options     

王绵之治疗月经不调的治则及经验

介绍王绵之教授诊治女子月经不调的治则和经验。王老认为女子的月经来潮主要涉及肾、肝、脾三脏,提出治则"辨证立法,治标先治本",强调治疗月经不调主要从肝、肾、脾论治,用药应侧重疏肝理气,补脾肾;同时,王老认为女子月经是以阴血为物质基础,阴血运行异常是月经不调发生的直接原因,因此提出治则"辨证审因,治标不忘本",从血虚、血瘀、血寒、血热四个方面对患者的血分异常进行严格的辨证审因,进而对症用药。此外,王老对于药物配伍也颇有研究,重在养血而不留瘀,活血而不伤正,心思奇巧,用药精准。该文详尽阐述了王老治疗月经不调的治则与经验,为之后学者研究月经不调提供了研究思路。     

数字人体离散动态系统的离散动力学与离散混沌

本文将讨论数字人体的离散动态系统,主要研究离散动力学与离散混沌。本文涉及到的离散动态人体系统实际上包含两类：一类是把人体系统的连续时间进行离散化,即把时间当作迭代的步骤(时间间隔相等)或一次逻辑转移(时间间隔可能不相等),状态变量仍为连续的;另一类是状态变量的离散化,离散型状态变量不论是数字的还是符号的,它们都只具有逻辑代数和结构。     

Potential users’ preferences towards cardiac telemedicine: A discrete choice experiment investigation in Sardinia

Background

Potential users’ preferences for telemedicine services directed to cardio-vascular diseases are investigated applying a discrete choice experiment (DCE). Given the potential of telemedicine to minimize costs without reducing overall efficiency, assessing preferences for these types of services represents a priority for policy makers. This is especially true for those pathologies that absorb a relatively high quota of total health expenditure. The empirical setting is Sardinia (Italy) because of its insularity and the underdeveloped internal transport network. Telemedicine is likely to mitigate distance between healthcare providers and final users.

Training discrete trials teaching skills using videoconference

This study investigated the effect of videoconferencing in training staff to implement discrete trial teaching in real life settings with children with autism. Fourteen participants were randomly assigned to two groups. One group received training on-site and the other group received training via videoconference. The participants in both groups received 3× 15 min of training on three different teaching programs: matching, receptive and expressive labeling. The results showed no significant differences between the groups in the post-test whilst both groups improved significantly following training. Although preliminary, these results suggest that videoconferencing can be a cost-saving way to train staff in how to implement discrete trial teaching.     

硬脑膜动静脉瘘的治疗分析（附15例报告）

目的探讨硬脑膜动静脉瘘的治疗方法及其效果。方法回顾性分析2010年9月到2012年9月收治的15例硬脑膜动静脉瘘病人的临床资料。手术治疗4例,血管内治疗7例,伽玛刀治疗2例,保守治疗2例。结果手术治疗的4例患者均恢复良好。血管内治疗的7例患者中,5例术后即刻行造影显示硬脑膜动静脉瘘消失,未发生并发症;另2例栓塞后有少量残留,通过压迫供血的颈总动脉治愈。伽玛刀治疗2例,随访1年症状好转。保守治疗的2例患者,通过压迫供血的颈总动脉,其中1例成功治愈,另1例好转。15例患者出院后随访6～30个月,7例血管内治疗患者中2例复发,1例再次栓塞后治愈,1例通过压迫供血的颈总动脉及伽玛刀治疗后好转;随访期间15例患者均无神经功能缺失表现。结论硬脑膜动静脉瘘应针对其部位及类型,选择相应的治疗方法;血管内治疗安全、有效,是其首选方法。