基于 Shapiro 模型推理算法的智能知识获取在中医知识库中的实现

本文应用现代计算机技术,将Shapiro模型推理算法运用于中医知识库中,使该知识库系统具有智能知识获取的能力.     

Model identification and estimation of organ-function parameters using radioactive tracers and the impulse-response function

Examination of the input-output events in functioning organs by the use of the impulse-response function (IRF) for a radioactive tracer is gaining more and more ground in nuclear medicine. This study summarizes the development of deconvolution analysis, laying special stress on the model-free approach. System linearity and time invariance are discussed, and means of eliminating noise in IRFs originating from the input and organ-time-activity curves are outlined. Typical IRFs are illustrated by flow diagrams, time-domain curves, and their representation by Laplace transforms. The cases of nondiffusible and diffusible tracers as well as parenchymally extracted and transported substances are discussed. Methods for the derivation of models and for the calculation of physiologically important parameters from theIRFs are suggested.At present, a guest scientist at the Institute for Medicine, Nuclear Research Center Jülich, Jülich, Federal Republic of Germany     

A pharmacokinetic approach to the establishment of biopharmaceutic characteristics of different acetylsalicylic acid formulations in man

Eleven acetylsalicylic acid (ASA) formulations were administered to 26 healthy volunteers in a cross-over design. The properties of the preparations differed from conventional, effervescent, buffered to buccal. The objectives of this study were:

• 1 Consideration of the general aspects of a biopharmaceutical study: which parameter for which biopharmaceutic characteristic?
• 2 Measurement of the kinetic parameters of ASA: first-pass effect, mean residence time, mean appearance time, total body clearance, apparent volume of distribution, half-lives, etc.
• 3 Comparison of the formulations.

Most of the formulations yield mean residence times for ASA of 0.3–1.0h, which do not differ significantly (p > 0.05). For most of the products the first-pass effect is about 40 per cent; the average values of the apparent volume of distribution and whole body clearance, corrected for the first-pass effect, are about 201 and 650 ml min^?1, respectively. Peak levels are reached slowly for the buccal formulations, and rapidly for the buffered products. It is difficult, especially for ASA, to characterize the gastro-intestinal absorption with pharmacokinetic model parameters, because the first-pass effect is large and often elimination of ASA is faster than absorption. The model-independent approach has the special advantages of calculating reliable pharmacokinetic parameters, and creating theoretical possibilities to characterize the absorption patterns of the different formulations in a quantitative way. No significant differences in the values of the parameters are found between most of the formulations. The ASA first-pass effect is reasonably constant and buccal application has no advantage. Enteric coating of the outer layer of ASA formulations causes inconsistent absorption and may be categorized under ‘artificial mistakes’.     

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。     

公共卫生本科生实践能力培养长效机制的模型探索

目的 探索和构建公共卫生本科生实践能力培养长效机制的模型。方法 查阅文献、问卷调查和访谈以构建模型,通过对照组和干预组统计学分析和开展问卷满意度调查来分析模型的可行性,数据分析采用t检验、秩和检验,统计分析使用Stata 14软件。结果 干预组和对照组实践能力总计分数差异有统计学意义(t = 2.660,P = 0.002),综合实践能力分数差异有统计学意义（t = 6.656,P＜0.001）。学生满意度,就业机构或升学学校满意度分析均提示模型能够提升学生的实践能力。结论 模型具有可行性,为进一步提升公共卫生本科生实践能力提供了方法实践。     

运用DEA模型分析武进区县域医共体模式下公立医疗机构运行效率△

目的:基于DEA-BCC模型,评价常州市武进区公立医疗机构运行效率,为县区级医院医共体优化资源配置提供参考。方法:选取该区18家公立医疗机构2018-2020年的全国卫生健康财务年报数据,从中筛选出投入产出指标,采用DEA数据分析方法,评价其运行效率。结果:18家公立医疗机构综合运行效率均有所提升,不同层级的医疗机构、乡镇卫生院存在差异,乡镇卫生院的综合运行效率偏低。三年间,乡镇卫生院的总体综合效率值均小于1,DEA均为无效;2018-2020年乡镇卫生院的规模报酬均为不同程度的递减状态;仍有部分医院存在资源利用不充分或过剩等问题。结论:政府应将医疗卫生资源改革的重点放在建立多专业的质控中心,不断提升基层医疗机构服务能力;合理控制各级医疗机构发展规模,促进基层医疗卫生资源的有效整合;明确医共体单位功能定位,实现错位发展。     

基于Framingham模型的苏州市9～18岁学生近视风险模型的构建

目的　探讨苏州市学生近视主要影响因素,建立近视的风险模型,为学生近视综合防控提供依据。方法　分层整群随机抽样招募苏州市四至十二年级学生为调查对象,通过标准化问卷收集学生年龄、性别、饮食习惯、用眼环境、读写习惯、近距离用眼、户外活动、睡眠及父母近视史等,现场测量教室照明,对每名学生进行屈光检测和裸眼远视力检查。Logistic回归分析近视的影响因素,Framingham模型构建近视风险评分模型。结果　本次纳入9～18岁学生2 859人,近视2 264人,近视检出率为79.19%。Logistic回归分析显示,女性（OR = 1.544,95%CI:1.258～1.896）、年龄（OR = 1.404,95%CI:1.325～1.487）、父母近视（一人近视:OR = 2.114,95%CI:1.694～2.638;均近视:OR = 3.450,95%CI:2.590～4.594）、黑板面照度不合格（OR = 1.316,95%CI:1.017～1.703）和躺着或趴着看书或电子屏幕（OR = 1.464,95%CI:1.099～1.950）是中小学生近视的危险因素。Framingham近视风险模型ROC曲线下面积为0.755（95%CI:0.733～0.777）,最佳临界值点为6.6,灵敏度为68.3%,特异度为70.9%,约登指数为39.21%（95%CI:34.90%～42.35%）。结论　Framingham近视风险评分模型具有较好的近视预测能力,可用于近视的健康管理和干预。     

及时开展新冠疫情防控与大规模核酸检测的卫生经济学评价

目的 对广州市于第二波新冠疫情及时开展疫情防控以及大规模核酸检测进行卫生经济学评价。方法 基于全社会角度,从相关部门及文献中收集数据,对广州市的所有常住居民构建改进SEIR模型,通过构建不同情景,分析真实世界情景及疫情防控措施分别推迟3天与7天的情景下的结果产出值,并对广州市四轮大规模核酸检测行成本效益分析。结果 真实世界情境下,本轮疫情的总经济负担约为344.02亿元人民币。与及时开展疫情防控措施相比,推迟3天开展疫情防控措施会带来1 391例累计确诊病例、43例死亡以及额外的141.91亿元人民币的经济负担。而推迟7天开展疫情防控措施会带来26 237例累计确诊病例、882例死亡以及额外的294.62亿元人民币的经济负担。四轮大规模核酸检测的净收益为221.82亿元人民币,效益成本比为24.23。结论 面对疫情时及时开展疫情防控措施能够极大地减少经济负担,且进行大规模核酸检测具有良好的经济性。     

成都市暴雨洪涝与儿童手足口病关联分析及脆弱人群亚组识别

目的 刻画成都市2011—2017年暴雨洪涝与儿童手足口病(Hand, foot and mouth disease,HFMD)之间的短期滞后关系,并进一步量化在不同性别、年龄亚组中的效应,识别脆弱人群。方法 收集整理成都市2011年1月1日—2017年12月31日的15岁以下HFMD日发病数、气象因子和暴雨洪涝发生情况数据。以暴雨洪涝为关键自变量,运用准泊松分布滞后模型,探讨了暴雨洪涝发生后0~14天的滞后效应。结果 研究发现暴雨洪涝与儿童手足口病呈正相关关系。0~7天和0~14天的累积滞后效应分别为1.11(95% CI:1.01~1.22)和1.21 (95% CI:1.04~1.41)。性别和年龄亚组分析分别表明,男童和3岁以下儿童（<1岁婴儿和1~2岁幼儿亚组）存在单日滞后统计显著的正相关关系,且0~7天和0~14天的累积滞后均显著;女童的单日滞后没有统计学意义,仅0~14天累计滞后统计显著,且效应略低于男童（女童: RR =1.23(1.00~1.51),男童: RR =1.26(1.06~1.51)）;<1岁婴儿0~7天和0~14天的累积滞后效应最强,分别为1.26(95%CI:1.02~1.57)和1.68(95%CI:1.20~2.34)。结论 暴雨洪涝会增加儿童患HFMD的风险,尤其是男童和3岁以下的婴幼儿（对1岁以下的婴儿的影响最大）。利益相关者应充分意识到暴雨洪涝的健康风险。家庭、社区、学校和政府应共同努力,减少暴雨洪涝相关的儿童HFMD。     

How Do Dieticians on Instagram Teach? The Potential of the Kirkpatrick Model in the Evaluation of the Effectiveness of Nutritional Education in Social Media

The growing popularity of health education on social media indicates the need for its appropriate evaluation. This paper aims to present the potential of the Kirkpatrick Model (KM) with New World Kirkpatrick Model (NWKM) additions to evaluate the nutritional education provided by dieticians via Instagram. Instagram profiles of ten dieticians providing nutritional education for their followers were analyzed in March and April 2021. The study sample included profiles of both macro- and micro-influencers. The analyzed quantitative data included Instagram Engagement Rate and the number of likes and comments per post. The qualitative analysis of the comments was performed following the theoretical framework provided by the KM and NWKM. Collected data showed followers’ satisfaction, commitment, and relevance of the presented content, fulfilling the Level 1 of NWKM. Level 2 of NWKM was represented by 4 out of 5 dimensions (knowledge, attitude, confidence, commitment). No comments were found only for skills. Both Levels 3 (Behavior) and 4 (Results) of the KM were met. However, the use of the NWKM for them seems limited. The KM can be used to evaluate nutritional education on social media. The NWKM additions seem applicable mostly for Levels 1 and 2.