Psychometric Characteristics of the Headache-Specific Locus of Control Scale

Martin and colleagues have described their development of a Headache-Specific Locus of Control scale (HSLC) which contains 11 items for each of its three subscales: internal, health care professional, and chance orientations. In this replication study, we gathered data from patients who came to a Headache Clinic in a medical center (n = 151) and from a comparison sample (n = 192). Factor analysis and alpha coefficients were similar to those reported by Martin. Only small correlations were found between the subscale scores although some of them were statistically significant. This suggests that the HSLC is a psychometrically competent instrument. Additionally, mean scores of its three subscales differentiated the patient population from those whose headaches were less severe and thus did not seek help.     

Fundamentals of feedback control applied to microcomputer instrumentation design

Summary Feedback control is widely used in applications which range from simple control of room temperature to very sophisticated control of space flight. This paper describes some fundamentals of feedback control as they apply specifically to microcomputer based medical devices. A classical controller is described in its analog and digital implementations. Reference is made to methods for adjusting or tuning the controller for specific applications. Successful applications of adaptive or self-tuning control are discussed. Examples of feedback control include systems to control arterial blood pressure by the infusion of sodium nitropruside, systems to control arterial carbon dioxide concentration by mechanical ventilation and systems to control depth of anesthesia by controlled anesthesia delivery.     

A Survey of Persons Who Use Integrated Control Devices

Integrated devices allow users to operate multiple pieces of assistive technology items from a single input device. Through this single input device, users with severe physical limitations are able to operate several other devices such as a wheelchair, telephone, computer, and communication aid. Twenty-four integrated control users completed a telephone survey to ascertain consumer satisfaction with integrated controls. Eighteen were either satisfied or very satisfied with the evaluation for an integrated control, one was neither satisfied nor dissatisfied, two were very dissatisfied, and three did not respond to the question. Twenty were very satisfied or satisfied and four were either dissatisfied or very dissatisfied with the training they received. Twenty-two respondents indicated they were either very satisfied or satisfied with their integrated control device, one was neither satisfied nor dissatisfied, and one was very dissatisfied. In general, respondents were satisfied with their integrated control devices. Specifically, respondents were satisfied with the increase in independence and the ability to control other equipment such as television sets and computers. Simplicity, touch sensitivity, and visual/auditory feedback appeared to play important roles in satisfaction.     

三相并网逆变器静止坐标系零稳态误差电流控制分析及在线切换控制研究

电流控制是三相并网逆变器运行的关键问题之一。为了实现快速准确的电流控制,深入分析了三相并网逆变器旋转坐标系PI控制、静止坐标系PR控制和静止坐标系PCI控制三者之间的联系和区别,证明了静止坐标系PR控制和旋转坐标系PI控制两者并不等效,探讨了静止坐标系PR控制和PCI控制在动态性能和稳态性能方面的特点,并提出一种在线平滑切换方案,有效利用两者的优势,最后搭建了基于TMS320F2812 DSP的数字控制实验平台,完成了电网电压平衡/不平衡两种情况下的实验测试,为不同工况下合理选择控制策略提供了重要的理论依据。     

Pharmacologic Rate versus Rhythm‐Control Strategies in Atrial Fibrillation: An Updated Comprehensive Review and Meta‐Analysis

Background : In patients with atrial fibrillation (AF), ventricular rate control with medications has been found to be noninferior in preventing clinical events, compared to a strategy converting patients to sinus rhythm and maintaining it with medications. Guidelines have accepted rate control as an acceptable therapeutic option. Most of the prior studies excluded patients without significant left ventricular dysfunction, or permanent AF. Methods : The authors searched the PubMed, CENTRAL, and EMBASE databases for randomized controlled trials from 1966 to 2011. Trials included were direct head‐to‐head comparisons of rate‐ and rhythm‐control strategy using pharmacological means. The primary outcome assessed was risk of all‐cause mortality. We also assessed other pooled clinical endpoints using a random effects model (Mantel‐Haenszel) between rate and rhythm‐control strategies. Results : Ten studies (total N = 7,867) met inclusion/exclusion criteria. In‐hospital mortality was not different between groups (P = 0.31). The rates of stroke, systemic embolism, worsening heart failure, myocardial infarction, and bleeding were also similar. However, rates of rehospitalization were much lower with a rate‐control strategy (P = 0.007). An exploratory analysis in patients younger than 65 years revealed a rhythm‐control strategy was superior to rate control in the prevention of all‐cause mortality (P = 0.0007). Conclusions : This systematic review suggests no difference in clinical outcomes with a rate or rhythm‐control strategy with AF. However, rehospitalization rates appear to be lower with pharmacological rate control for all ages, while finding support for rhythm control in younger patients. (PACE 2013; 36:122–133)     

Clinical review: clinical management of atrial fibrillation - rate control versus rhythm control

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in the critically ill and is associated with adverse outcomes. Although there are plausible benefits from conversion and maintenance of sinus rhythm (the so-called 'rhythm-control' strategy), recent randomized trials have failed to demonstrate the superiority of this approach over the rate-control strategy. Regardless of approach, continuous therapeutic anticoagulation is crucial for stroke prevention. This review addresses the findings of these studies and their implications for clinical management of patients with atrial fibrillation.     

阳极端效应及其在肢体投照中的应用

本文通过对X线管阴阳极端X线强度差异的测定，探讨了阳极端效应的规律以及在临床投照工作中的应用。10台X线机测定结果示X线管阴阳极两端X线强度分布差异为20～70％。临床实践证明阳极端效应在肢体投照中应用的必要性和可行性，对平衡照片密度有一定价值。作者建议在日常投照工作中，对X线机阳极端效应进行监测；掌握和利用X线这一不可避免的现象而改善照片质量。同时对减少阳极端效应的影响提出了看法。     

Cell Dyn-1700血液分析仪质控规则选择

目的选择CellDyn1700血液分析仪质控规则。方法根据CellDyn1700血液分析仪所做的室内质控和室间质控确定仪器的不精密度(CV)和不准确度(bias),根据公式:ΔSec=[(Tea-|bias|)/s]-1.65计算出临界系统误差,然后参考王治国等人制作的单规则固定限和多规则质控选择及设计表格,选定合适的质控规则和控制测定值个数(n)。结果CellDyn1700血液分析仪测定血细胞时白细胞(WBC)、红细胞(RBC)、血红蛋白(Hb)、平均红细胞体积(MCV)、平均红细胞血红蛋白浓度(MCHC)选择1-2.5s规则(n=1),平均红细胞血红蛋白含量(MCH)选择1-2s规则(n=1),红细胞压积(HCT)、血小板(PLT)选择Westgard多规则13s/22s/R/4(n=2)。结论试验测定项目不同,测定值个数不同,选择的质控规则也不同。     

质控方案设计工具在室内质量控制中的应用

目的:应用几种质控方案设计工具,根据我室现有检测方法实际性能设计理性的室内质量控制方法。方法:依据美国 CLIA’88能力验证计划的分析质量要求确定临床总允许误差(TEa),以长期室内质量控制的数据估计各方法的不精密度(CV%),以参加卫生部临床检验中心的能力对比检验(PT)成绩估计不准确度(bias%),以此计算临界误差的大小,按照方法的过程能力大小使用质控选择表格进行规则的初期选择,并用功效函数图确认质控方法的性能,确定到达特定水平质量保让时,不同规则及每批测定质控个数需检出的临界误差大小,并建立操作过程规范图。结果:我室总胆红素(TB)、肌酐(CREA)、胆固醇(CHO)的测定在低值水平处方法性能较差,不能很好地检测出误差,需要查找原因进行质量改进,其他项目可根据方法性能选择不同的规则进行控制。结论:通过质控方案设计工具的使用,建立适合本室的方法控制规则,既保证测定结果能够满足临床的质量要求,又达到节约成本的目的,同时通过积极查找并解决不满意方法存在的问题,进行持续质量改进提高我室的过程能力。     

利用电子表格设计基于患者风险的定量项目室内质控策略初探

摘要：探讨基于患者风险的定量项目室内质控策略，利用电子表格EXCEL编辑函数，计算当前质控策略下可能发出的不可靠患者结果的数量，绘制相关示意图，并利用实例帮助实验室进行基于患者风险的个性化质控策略设计。     

XS-1000i血液分析仪质量控制规则的选择和分析

目的根据本实验室的实际工作情况,为XS-1000i血液分析仪选择质量控制(下称质控)规则。方法根据XS-1000i血液分析仪所做的室内质控和全球质评确定仪器的不精密度(CV)和不准确度(bias),利用操作过程规范图(OPSpecs)法选择合适的质控规则和控制测定值个数(n)。结果试验测定项目不同,测定值个数不同,选择的质控规则也不同。低值:WBC选择13s/22s/R4s/41s/10x规则(n=3),RBC、MCV选择13s规则(n=2),HGB、PLT选择13s/22s/R4s/41s/10x规则(n=2);中值:HGB选择13s/22s/R4s规则(n=2),WBC、RBC、PLT、MCV选择13s规则(n=2);高值:WBC、PLT、MCV选择13s规则(n=2),RBC、HGB选择13s/22s/R4s规则(n=2)。结论临床实验室可根据实际情况利用操作过程规范图选择质控方案,从而有效控制实验室分析结果的质量。     

Evaluation of two adaptive sodium nitroprusside control algorithms

Computer control of sodium nitroprusside infusion may be safer and provide better control of arterial blood pressure than is achieved with manual control. In a series of test maneuvers in 20 mongrel dogs, the performance of two adaptive control algorithms(controllers) was compared and their safety tested. The controllers were set to infuse sodium nitroprusside to decrease mean arterial pressure and maintain it 20 to 30 mm Hg below the control pressure. Then, sequentially, the right atrium was paced to simulate a supraventricular tachydysrhythmia, the right ventricle was intermittently paced to simulate ventricular extrasystoles, large tidal volumes were given to simulate a respiratory-therapy maneuver, the catheter was clamped to simulate clotting, an air bubble was introduced, and the infused sodium nitroprusside concentrations were either doubled or halved. Next, 500 ml of blood was drawn. Then, in sequence, positive end-expiratory pressure was applied, the right atrium was paced, and large tidal volume breaths were given to cause the blood pressure to fluctuate. When the controllers were turned on, mean arterial pressure reached the set point and remained within 5 mm Hg of the target pressure after 8.6±0.9 minutes (mean ± SEM). The controllers properly handled the differences in sodium nitroprusside sensitivity and the catastrophic challenges presented in the experiments. When the animals were not being disturbed, stability was maintained and the blood pressure was kept well within 5 mm Hg of the desired pressure. The controllers rejected all invalid pressure signals during testing. During the challenges imposed by dysrhythmias, respiratory therapy, hypovolemia, and blood transfusion, the controllers returned the pressure to the desired value in less than 10 minutes. Under our test conditions, differences in behavior between the two controllers were not significant.     

A comparative study of virtual hand prosthesis control using an inductive tongue control system

This study compares the time required to activate a grasp or function of a hand prosthesis when using an electromyogram (EMG) based control scheme and when using a control scheme combining EMG and control signals from an inductive tongue control system (ITCS). Using a cross-over study design, 10 able-bodied subjects used a computer model of a hand and completed simulated grasping exercises. The time required to activate grasps was recorded and analyzed for both control schemes. End session mean activation times (ATs; seconds) for the EMG control scheme grasps 1 -5 were 0.80, 1.51, 1.95, 2.93, and 3.42; for the ITCS control scheme grasps 1 ?5 they were 1.19, 1.89, 1.75, 2.26, and 1.80. Mean AT for grasps 1 and 2 was statistically significant in favor of the EMG control scheme (p = 0.030; p = 0.004). For grasp 3 no statistical significance occurred, and for grasps 4 and 5 there was a statistical significance in favour of the ITCS control scheme (p = 0.048; p = 0.004). Based on the amount of training and the achieved level of performance, it is concluded that the proposed ITCS control scheme can be used as a means of enhancing prosthesis control.     

Use of statistical process control in the production of blood components

summary .  Introduction of statistical process control in the setting of a small blood centre was tested, both on the regular red blood cell production and specifically to test if a difference was seen in the quality of the platelets produced, when a change was made from a relatively large inexperienced occasional component manufacturing staff to an experienced regular manufacturing staff. Production of blood products is a semi-automated process in which the manual steps may be difficult to control. This study was performed in an ongoing effort to improve the control and optimize the quality of the blood components produced and gives an example of how to meet EU legislative requirements in a small-scale production centre. Data included quality control measurements in 363 units of red blood cells, 79 units of platelets produced by an occasional staff with 11 technologists and 79 units of platelets produced by an experienced staff with four technologists. We applied statistical process control to examine if time series of quality control values were in statistical control. Leucocyte count in red blood cells was out of statistical control. Platelet concentration and volume of the platelets produced by the occasional staff were out of control, which was not the case with the experienced staff. Introduction of control charts to a small blood centre has elucidated the difficulties in controlling the blood production and shown the advantage of using experienced regular component manufacturing staff.     

护理人员的前馈控制对血液标本质量的影响

目的探讨护理人员的前馈控制对血液标本质量的影响,提高血液检查结果的准确性,为临床医生提供可靠的诊断依据。方法将我院骨外科2016年1-2月的住院患者随机分成干预组和对照组,各230例,分别由干预组的护士与对照组的护士进行血液标本的采集,干预组实施前馈控制,对照组实施常规护理,对两组患者的血标本质量进行比较。结果对照组的血液标本质量的合格数215例(合格率为93.5%),不合格数15例,其中,标本凝固5例,标本溶血4例,标本脂血3例,标本采集量不足3例。干预组血液标本质量的合格数225例(合格率为98%),不合格数5例,其中标本凝固2例,标本溶血1例,标本脂血1例,标本采集量不足1例。两组标本合格率比较差异有统计学意义(P0.05)。结论向患者讲解、指导采血前的准备工作及注意事项,规范护理人员的操作技能,及时送检是血液标本分析前的重要质量保证。     

Effects of fatiguing treadmill running on sensorimotor control in athletes with and without functional ankle instability

Background

Sensorimotor control is permanently impaired following functional ankle instability and temporarily decreased following fatigue. Little is known on potential interactions between both conditions. The purpose was to investigate the effect of fatiguing exercise on sensorimotor control in athletes with and without (coper, controls) functional ankle instability.

Methods

19 individuals with functional ankle instability, 19 ankle sprain copers, and 19 non-injured controls participated in this cohort study. Maximum reach distance in the star excursion balance test, unilateral jump landing stabilization time, center of pressure sway velocity in single-leg-stance, and passive ankle joint position sense were assessed before and immediately after fatiguing treadmill running. A three factorial linear mixed model was specified for each outcome to evaluate the effects of group, exhausting exercise (fatigue) and their interactions (group by fatigue). Effect sizes were calculated as Cohen's d.

Findings

Maximum reach distance in the star excursion balance test, jump stabilization time and sway velocity, but not joint position sense, were negatively affected by fatigue in all groups. Effect sizes were moderate, ranging from 0.27 to 0.68. No significant group by fatigue interactions were found except for one measure. Copers showed significantly larger prefatigue to postfatigue reductions in anterior reach direction (P ≤ 0.001; d = − 0.55) compared to the ankle instability (P = 0.007) and control group (P = 0.052).

Interpretation

Fatiguing exercise negatively affected postural control but not proprioception. Ankle status did not appear to have an effect on fatigue-induced sensorimotor control impairments.     

人心肌肌钙蛋白I冻干质控品的制备及评价

目的制备性能稳定、具有良好免疫反应性的冻干人心肌肌钙蛋白I亚基(cTnI),用作cTnI定量检测试剂的质控品。方法利用基因工程方法构建表达载体,转化大肠埃希菌后,诱导表达重组cTnI,经纯化后制备冻干质控品,同时考察该质控品的稳定性。结果成功诱导表达可溶性cTnI蛋白,其冻干品与标准参考物质SRM 2921具有相同的免疫反应性,且该质控品用于检测具有良好的精密度和稳定性。结论制备的冻干cTnI使用方便、结果稳定,可以满足室内质控要求,适合作为cTnI定量试剂盒的质控品。     

Westgard多规则质量控制中2_(2S)规则的理解与应用

目的探讨Westgard多规则中2_(2S)规则在单一浓度质量控制中的应用条件。方法将2_(2S)规则适用范围拓展到单一浓度质控品的同批检测。结果 2_(2S)规则可以提高系统误差的检出率。结论 2_(2S)规则在使用单一浓度质控品时,应适用1个批次的2次检测,以提高系统误差检出的及时性。     

2006～2010年国家临床检验中心室间质量评价结果分析

目的对宜宾市二医院和医学科近几年来参加国家临床检验中心室间质量评价工作进行总结分析,通过室间对比来控制本实验室试验结果的准确性,进一步提高本实验室的检测水平。方法国家临床检验中心发放的免疫室间质评样本按本科化学发光免疫分析仪操作规程进行检测和结果判读,对国家临床检验中心回报的质评结果进行分析总结。结果 5年共完成9次455个内分泌与475个肿瘤标志物质评样本的测试,其中854个测试结果准确.正确率分别达88.4%与95.3%。结论本实验室应进一步加室内和室间质量控制工作,使用高质量的试剂,提高操作技术和责任心,以提高检测的准确率。     

品管圈活动对提高头颈肿瘤患者人工气道舒适度的效果

目的：探讨品管圈（ QCC ）活动在提高头颈肿瘤患者人工气道舒适度的应用效果。方法成立品管圈小组,通过品管圈活动分析影响人工气道舒适及气道排痰有效性的原因,并采取有效气道湿化、适时吸痰、舒适体位和促进睡眠等方法,将改进前后患者舒适状况进行比较。结果实施QCC活动后,人工气道患者的有效排痰、气道温湿度、吸痰、睡眠状况均得到改善（ t值分别为－4．278,－27．531,－18．860,－18．212;P＜0．01）;舒适度由39．40％提高至81．32％。品管圈活动目标达标率为120．91％,进步率为123．16％,最终形成护理操作标准化,建立人工气道护理质量标准及气管切开患者舒适护理常规,设计了一体化气切护理车。活动后,圈员的工作热情、个人表达能力、创造性思维、责任与荣誉、QCC手法运用及团队精神均有提高。结论运用品管圈对人工气道舒适管理,不仅提高了专科护理质量,还进行发明创造,为医院创造了经济效益及社会效益。