Correcting forensic DNA errors

DNA mixture interpretation can produce opposing conclusions by qualified forensic analysts, even within the same laboratory. The long-delayed publication of the National Institutes of Standards and Technology (NIST) study of 109 North American crime laboratories in this journal demonstrates this most clearly. This latest study supports earlier work that shows common methods such as the Combined Probability of Inclusion (CPI) have wrongly included innocent people as contributors to DNA mixtures. The 2016 President's Council of Advisors on Science and Technology report concluded, “In summary, the interpretation of complex DNA mixtures with the CPI statistic has been an inadequately specified—and thus inappropriately subjective—method. As such, the method is clearly not foundationally valid” [7]. The adoption of probabilistic genotyping by many laboratories will certainly prevent some of these errors from occurring in the future, but the same laboratories that produced past errors can also now review old cases with their new software—without additional bench work. It is critical that laboratories adopt procedures and policies to do this.     

教育信息化2.0背景下网络教育的现状及对策思考——以陕西省为例

《教育信息化2.0行动计划》发布以来,全国各地积极推动教育信息化的发展,网络教育变得越来越普及。虽然网络教育在发展的过程中也越来越完善,但是还存在着一些问题。文章通过分析陕西省网络教育的现状,总结目前存在的问题并提出相应的对策,有助于更好地发展和完善网络教育,为教育信息化的发展提供借鉴。     

某三级甲等医院监护仪使用规范性调查分析及安全对策

[目的]调查护士使用多参数监护仪各重点实践环节规范性,发现使用中可能导致病人安全风险的不规范操作,分析相关因素并提出安全对策。[方法]采用自行编制的调查问卷对162名护士进行调查,对护士一般资料、监护仪使用各重点环节得分进行统计描述和单因素方差分析,并针对问题环节及相关因素提出安全对策。[结果]护士使用多参数监护仪重点实践环节总得分为(72.39±6.93)分,得分率为72.39%。各重点环节得分率最高的是监护仪设置(84.42%),最低的是持续使用监护仪,仅为57.25%,其中定时更换电极片得分率最低(39.25%)。单因素方差分析结果表明不同年龄、护龄、职称、科室对重点实践环节总得分比较差异有统计学意义(P<0.05)。针对出现的问题提出制定统一监护仪操作规范,加强护士培训,完善监护仪使用相关管理措施等病人安全对策。[结论]目前护士使用监护仪存在诸多不规范环节,易造成监护仪使用相关病人安全风险,需积极制定并实施安全对策。     

新型冠状病毒肺炎疫情期间肺癌患者的应对措施

新型冠状病毒肺炎(COVID-19)是近段时间我国面临的重大公卫事件，我国是肺癌大国，为了加强肺癌患者对这一疾病的认识，在疫情期间，使广大肺癌患者做好自身疾病的管理，做好对新型冠状病毒肺炎的预防。本文结合肺癌患者自身特点，对新型冠状病毒肺炎的易感性、鉴别诊断、防护、治疗，以及肺癌患者的随访、抗肿瘤用药、营养、手术等方面进行探讨，并结合两者的关系综合归纳，可以为广大肺癌患者更好地应对疫情提供参考。     

膀胱肿瘤切除术后尿路感染病原学和危险因素

目的观察膀胱肿瘤切除术后患者尿路感染发生情况与病原学特征,分析诱发尿路感染的危险因素,并提出合理且具备针对性的冲洗对策,为未来膀胱肿瘤切除术后尿路感染的预防提供合理参考。方法回顾性分析连云港市第一人民医院2016年1月-2019年1月接受经尿道膀胱肿瘤切除术治疗的451例膀胱肿瘤患者的临床资料,收集患者病例资料,全部患者术后均定期取尿液标本进行细菌培养,参照相关标准判定患者尿路感染情况,记录患者一般情况,包括一般人口学资料(性别、年龄、体质量、受教育程度等),同时记录患者糖尿病的疾病合并情况,将术后尿路感染可能的危险因素纳入初步分析,Logistic多因素回归分析膀胱肿瘤切除术后发生尿路感染的危险因素。结果451例膀胱肿瘤切除术患者术后第3天尿液中细菌培养阳性例数为80例,阳性率为17.74%,在使用抗菌药物后,患者尿液中细菌培养阳性率逐渐降低,各时点尿液细菌阳性培养率比较,差异有统计学意义(P<0.05);经多因素Logistic回归分析检验证实,高龄、血糖水平控制不佳、术前留置导尿管、多发肿瘤是膀胱肿瘤切除术后尿路感染的危险因素(OR>1,P<0.05);80例术后尿液细菌培养阳性患者共分离出87株菌株,其中革兰阴性菌66株占75.86%,革兰阳性球菌21株占24.14%。结论膀胱肿瘤切除术后患者有较高的尿路感染风险,革兰阴性菌是主要的感染病原菌,年龄、基础疾病、肿瘤位点、术前导尿管留置等是影响因素,这类患者应引起临床高度重视。     

Maternal and procedural factors associated with estimated blood loss in second trimester surgical uterine evacuation: a retrospective cohort analysis

BackgroundPrior studies examining bleeding with uterine evacuation have focused on high-volume centers performing over 1100 procedures annually. The aim of this study was to examine associations between blood loss and patient and procedural characteristics in a center performing fewer than 50 procedures annually.MethodsThis retrospective cohort study, with institutional review board approval, utilized procedural codes to identify patients undergoing uterine evacuation procedures between 14 weeks’ and 24 weeks’ gestational age across a 50-month period. The primary outcome was estimated blood loss; secondary outcomes were hemorrhage, transfusion and hospital re-admission. Associations between blood loss and other variables were examined using linear regression models.ResultsCharts of 161 women met inclusion criteria. Median estimated blood loss was 400 mL (IQR 300 mL) with 37% of patients having blood loss of ≥500 mL. In univariate analyses, increased blood loss was associated with later gestational age (P <0.001) and pregnancy termination (P <0.001). In a multiple linear regression model, both remained significant. Each one-week increase in gestational age was associated with a 7.1% mean increase in estimated blood loss (95% CI 2.47% to 11.9%; P=0.003). Patients whose uterine evacuation was indicated for pregnancy termination had an 80.6% increase in blood loss compared with those with pre-operative fetal demise (95% CI 37.5% to 137.2%; P <0.001). Rates of peri-operative transfusion and re-admission for bleeding were <4%.ConclusionWhile blood loss may be greater in low volume centers, our transfusion and re-admission rates were low following second trimester uterine evacuation.     

Ethical,legal and professional accountability in emergency nursing practice: An ethnographic observational study

IntroductionAccountability in nursing practice is a concept that influences quality care, decision-making, safety standards and staff values. Therefore, understanding accountability and how it affects nursing practice could improve patient care and nurses’ working conditions.AimThe aim of this study was to find factors that influenced ethical, legal and professional accountability in emergency nursing practice.MethodsA qualitative ethnographic approach using participant observation through convenience sampling was employed as the data collection method, while ethnographic content analysis was used for data analysis.ResultsThe factors linked to nursing accountability found were classified into four main themes: daily dynamics, work environment evolution, customs and routines and bioethics principles’ application.DiscussionThe long-term effect of chronic high workload and crowding, which affects nursing accountability, could promote burnout in a junior ED workforce. Changes in the nurses’ working conditions need to be implemented to limit the workload to which an ED nurse is subjected to.ConclusionED nurses have to manage their accountability in difficult situations regularly, which followed patterns of four main themes across the majority of situations. Nonetheless, all those factors were influenced by nursing workload, an ever-present factor that was always considered by ED nurses during decision-making.     

Evaluation of fosphenytoin,levetiracetam, and propofol as treatments for nerve agent-induced seizures in pediatric and adult rats

Multiple recent instances of nerve agent (NA) exposure in civilian populations have occurred, resulting in a variety of negative effects and lethality in both adult and pediatric populations. Seizures are a prominent effect of NAs that can result in neurological damage and contribute to their lethality. Current anticonvulsant treatments for NAs are approved for adults, but no approved pediatric treatments exist. Further, the vast majority of NA-related research in animals has been conducted in adult male subjects. There is a need for research that includes female and pediatric populations in testing. In this project, adult and pediatric male and female rats were challenged with sarin or VX and then treated with fosphenytoin, levetiracetam, or propofol. In this study, fosphenytoin and levetiracetam failed to terminate seizure activity when animals were treated 5 min after seizure onset. Propofol was effective, exhibiting high efficacy and potency for terminating seizure activity quickly in pediatric and adult animals, suggesting it may be an effective anticonvulsant for NA-induced seizures in pediatric populations.