我国环境监测实验室土壤铅检测能力比对分析

为了解环境监测系统土壤中铅的检测能力,提高数据的准确性和可比性,笔者于2016年11月开展了环境监测实验室间比对研究,采用稳健统计法对比对结果进行了分析,对参与比对的实验室能力进行了评价,并对不同检测方法、不同级别实验室的检测结果进行了比较。结果显示,共有305个实验室参加比对,结果满意的单位有254个,占83.3%。比对结果的稳健变异系数较小。不同检测方法中火焰原子吸收法结果满意率最低。提示我国环境监测实验室的土壤铅检测能力较好,个别实验室的结果出现了较大的偏差,应该采取相应的纠正措施。     

化妆品中砷含量测定能力验证不满意结果探究

目的对化妆品中砷含量测定的能力验证(CNAS T0709)为不满意结果进行了多方面的原因排查,原因分析,讨论探究,并及时采取了纠正措施。方法《化妆品安全技术规范》(2015版)第四部分砷,第一法原子荧光光度法。结果 (1)在前处理方法方面由于考虑到化妆品成分中有机质含量较高,可能含有甘油等溶剂,采用了干灰化法;(2)取样稀释不合理影响结果的准确性。样品中砷含量相对较高,而制定的标准曲线的浓度相对较低,造成稀释倍数过大和稀释步骤增多;(3)未对样品测定结果作加标回收校正也是导致此次实验结果严重偏低的重要原因之一。结论人、机、料、法、环对测定结果的重要性,对仪器的校准报告进行确认并使用校准报告对仪器进行必要的校准。对方法要进行验证试验,确保实验室检测能够满足方法的要求。对加标回收率较低的检测在报告结果时要运用加标回收对结果进行校正,确保检测结果的准确可靠。     

ELISA法检测血清中HBsAg的结果不确定度分析

目前ELISA法在临床检验中已被广泛应用,具有一定的代表性,而有关ELISA法检测结果的不确定度评定的应用报道很少。本文根据JJF1059-1999（测量不确定度评定与表示》,通过对典型例子不确定度的分析和量化,建立了ELISA法检测HBsAg结果不确定度的评定程序,通过对检测结果不确定度的评估,对检测结果进行完整地表达,避免或降低了出现假阴性结果的风险。     

老年人梅毒胶体金假阳性结果的实验室排查

目的对老年人梅毒胶体金结果进行鉴别。方法利用综合分析手段对一例老年人梅毒胶体金假阳性结果进行排查。结果通过对留样再测、更换试剂批号、使用其它试剂复核、重新采样等结果的综合分析,最终排除了其梅毒感染的可能。结论老年人梅毒胶体金阳性,要使用多种方法复核及结合其它临床资料及生活史来排除其结果的假阳性,避免给出不正确的结果。     

2009年度上海地区放射影像设备主流厂商售后服务满意度调查分析

目的：推动医疗设备售后服务持续完善。方法：以上海2009年第3次对医疗放射影像类设备的主流厂商的售后服务满意度进行调查的结果为依据,对结果进行统计分析。结果：将统计分析结果结合横向比较进行排名并公布,分数及排名上都有一定的变化。结论：通过3年的连续实践,提高了售后服务管理水平,促进了各厂商对售后服务的重视和改进。     

活塞压力计活塞有效面积的测量与不确定度评定方法研究

目的与实际工作结合,研究获得较小重复性的活塞压力计活塞有效面积的测量和不确定度评定方法。方法对各量程的活塞进行实验,和对结果进行评定,并用该结果与溯源结果进行对比,分析其得到的不确定度的可靠程度。结果通过分组测量的方法,得到了较小的重复性,且结果具有较高可信度。结论利用分组测量方法在保证结果科学可靠的同时,减小了测量重复性。     

医疗机构间检验结果互认的可行性研究

本研究在分析以往实验室质量控制资料基础上,对医疗机构检验质量进行了现场调查,对医疗机构间检验结果互认进行了可行性分析。结果显示:同等级医疗机构间可以逐步开展检验结果互认;不同等级医疗机构间目前尚不宜广泛开展检验结果互认;确定实施结果互认的专业项目应遵循由易到难的原则;在实施检验结果互认时,应加强检验质量的监督管理。     

应用标化合格率评价食品卫生监测结果的探讨

目的本论文以深圳市龙岗区2008—2011年食品卫生抽检为例,对食品卫生监测结果的评价方法进行了探讨。方法根据食品卫生抽样检测结果,对实例中各年度食品卫生抽检标化合格率和平均合格率进行了计算,并对比计算结果。结果实例的各年度标化合格率较为接近,平均合格率存在较大差异。标化合格率能够客观反映出食品卫生的质量,可以对抽样过程中混杂因素的影响进行排除。结论针对食品卫生监测结果,应采用较为合理、科学的标化合格率进行评价。     

高效液相色谱法测定饮料中糖精钠不确定度评定研究

目前，我国在计量测试和疫病控制分析领域，对测量不确定度的表述和评定已较为普遍，但在分析化学领域，尤其是在食品分析领域，对分析结果的测量不确定度评定还较少见。本文依据中国实验室国家认可委编写的《化学分析中不确定度的评估指南》，运用现代统计学理论对影响分析结果的因素进行了讨论分析，就食品饮料糖精钠测定结果的不确定度进行了评定，确定了分析结果的报告值。     

二硫化碳作业工人心血管系统改变的观察

自从人们认识到二硫化碳可引起动脉硬化和冠心病以来,国内外学者对此作了多方面的研究,结果不尽相同。为了解二硫化碳对心血管的影响,我们对某厂二硫化碳作业工人进行了调查研究,其结果整理如下。     

A class comparison method with filtering-enhanced variable selection for high-dimensional data sets

High-throughput molecular analysis technologies can produce thousands of measurements for each of the assayed samples. A common scientific question is to identify the variables whose distributions differ between some pre-specified classes (i.e. are differentially expressed). The statistical cost of examining thousands of variables is related to the risk of identifying many variables that truly are not differentially expressed, and many different multiple testing strategies have been used for the analysis of high-dimensional data sets to control the number of these false positives. An approach that is often used in practice to reduce the multiple comparisons problem is to lessen the number of comparisons being performed by filtering out variables that are considered non-informative 'before' the analysis. However, deciding which and how many variables should be filtered out can be highly arbitrary, and different filtering strategies can result in different variables being identified as differentially expressed. We propose the filtering-enhanced variable selection (FEVS) method, a new multiple testing strategy for identifying differentially expressed variables. This method identifies differentially expressed variables by combining the results obtained using a variety of filtering methods, instead of using a pre-specified filtering method or trying to identify an optimal filtering of the variables prior to class comparison analysis. We prove that the FEVS method probabilistically controls the number of false discoveries, and we show with a set of simulations and an example from the literature that FEVS can be useful for gaining sensitivity for the detection of truly differentially expressed variables.     

The utilization of health services : Sequence of visits to general practitioners

Multivariate studies of health services utilization have been particularly disappointing. Some of the difficulties might be within the conceptualization of the utilization concept. The purpose of this paper is to suggest that propensity to utilize should be expressed in time sequences and that an explanation should be sought for such sequences, rather than for the total number of times physicians are consulted. Using data from the universal health insurance scheme in Québec, the concept of sequence of visits is illustrated, while variations in utilization patterns are better explained by the sequences of utilization than by age and sex.     

Significance testing for small microarray experiments

Which significance test is carried out when the number of repeats is small in microarray experiments can dramatically influence the results. When in two sample comparisons both conditions have fewer than, say, five repeats traditional test statistics require extreme results, before a gene is considered statistically significant differentially expressed after a multiple comparisons correction. In the literature many approaches to circumvent this problem have been proposed. Some of these proposals use (empirical) Bayes arguments to moderate the variance estimates for individual genes. Other proposals try to stabilize these variance estimate by combining groups of genes or similar experiments. In this paper we compare several of these approaches, both on data sets where both experimental conditions are the same, and thus few statistically significant differentially expressed genes should be identified, and on experiments where both conditions do differ. This allows us to identify which approaches are most powerful without identifying many false positives. We conclude that after balancing the numbers of false positives and true positives an empirical Bayes approach and an approach which combines experiments perform best. Standard t-tests are inferior and offer almost no power when the sample size is small.     

Residual insecticides and the problem of sorption

Whereas laboratory investigations have elucidated the mechanism of sorption of residual insecticides and demonstrated that their persistency is determined by a number of physico-chemical factors and is therefore theoretically calculable, the variables encountered in the field may produce results in apparent conflict with those theoretically expected. Attempts to enhance persistency through the prevention of sorption, although promising, have so far not been fully successful. It is consequently also necessary to assess the residual effectiveness of insecticides, “effectiveness” here being viewed as a biological effect expressed in terms of the mosquito mortality produced. For this purpose bio-assay tests have been used, but with very variable results, and it is suggested that a study of the bio-assay technique itself is needed. This should be conducted in parallel with chemical determinations of the total amount of insecticide present both on and below the sprayed surface.     

Influence of 'framing effect' on women's support for government funding of breast cancer screening

OBJECTIVES: To explore whether Australian women's support for government funding of mammographic screening is influenced by 'framing effect'. METHOD: Self-administered survey of 701 women in general practice to elicit their support for government funding of each of four mammographic screening programs where benefits were expressed as a relative risk reduction (RRR); absolute risk reduction (ARR); number needed to screen (NNS) and number of cases detected for additional death avoided. RESULTS: The proportion of respondents indicating they 'definitely would support funding' was significantly greater when benefits were expressed as RRR than ARR (chi 2(1) = 148.4, p < 0.0001), NNS (chi 2(1) = 126.4, p < 0.0001) or number of cases detected for additional deaths avoided (chi 2(1) = 29.0, p < 0.0001). 55.8% of women were not influenced by 'framing effect'. Younger women and those with higher educational levels were more likely to be susceptible to 'framing effect'. CONCLUSION: Having demonstrated its influence among these women, 'framing effect' should be acknowledged in future research.     

Parental sex effect in families with alcoholism

Parental sex effects have been shown to influence the inheritance of a number of complex disorders. In this paper we performed affected sib-pair analyses on 105 families with recurrent alcoholism to evaluate the effects that the parent of origin might have on this disorder. Three alternative classification schemes were used and the families were grouped as maternal, paternal, mixed, or unknown. Paternal effects were observed at D9S64, D16S475, and D16S2622, while maternal effects were expressed at FABP2, D8S280, D8S1715, and D8S1988. Except for D16S2622, none of these markers resulted in a significant p-value when all families were analyzed together. These results suggest that the parental sex should not be ignored and that a discriminatory analysis should always be performed.     

A review of a surgical ward round in a large paediatric hospital: does it achieve its aims?

The review which this paper outlines aimed to explore whether the ward round of the surgical team at Birmingham Children's Hospital achieved its objectives and to investigate the attitudes of medical and nursing staff, patients and their parents towards the round. Initial open-ended interviews generated themes from which questionnaires were constructed and administered to 16 members of the surgical team, 30 nurses, 14 patients and 24 parents. The surgical team generally felt that the round plays a valuable role whereas the nursing team expressed dissatisfaction with many aspects of the round. The majority of the surgical and nursing team thought that the round should change from its present form and a number of suggestions were made as to how changes in the round could improve the quality of the teaching experience and promote quality in patient care. Patients tended to express rather neutral feelings towards the round although a significant minority of parents expressed concerns over confidentiality and the level of anxiety felt by children. It is hoped that the results of this review will be used to inform changes in the way the round is carried out. A further review will be initiated in the future to evaluate the efficacy of any such changes.     

宫颈癌危险因素病例对照研究

目的 探讨宫颈癌高发区的相关危险因素。方法 采用以住院患者为基础的病例对照研究方法，对129名经病理确诊的宫颈癌患者和143例非肿瘤病人对照进行有关月经、婚育史、性行为与避孕史、个人卫生习惯等因素的调查。结果 在单因素分析的基础上进行多元Logistic回归分析，最终引入回归方程的变量为家庭经济收入、首次性交年龄、洗澡设施、妇科病史、产次和绝经，而结婚年龄、首次发生性行为和孕育年龄、孕产次等生殖因素，则与宫颈癌发生的危险性呈剂量一反应关系。结论 经济收入低、首次发生性行为的年龄小、既往有妇科病史、孕产次多可增加宫颈癌发生的危险性，特别值得注意的是洗澡和清洗阴部少等不洁卫生习惯可能是导致当地该病高发的原因之一，绝经后妇女宫颈癌发生的危险性较低。     

Five years' experience of combined impedance and audiometric screening at school entry

Many papers and pilot studies have considered whether school entry auditory screening should include testing with tympanometry. Some of these papers expressed concern that this type of screening would lead to an excessive number of failures and an overloading of ENT facilities. School children in the Worcester district have been screened at school entry using tympanometry, combined with pure tone audiometry, for the past five years. This paper describes how the combined screening programme was set up, and the advantages that have accrued. It also shows that combined testing has not significantly increased the number of children referred to ENT. The author suggests that this combined tympanometry and audiometric screening should become the accepted way to screen school entrants.     

Do formal controls always achieve control? The case of triage in accident and emergency departments.

Triage is the term used to describe the formal process of assigning urgency categories to patients arriving in a hospital accident and emergency department. This paper uses insights from literature on management control, medical sociology and nursing to illuminate the results of a research study comparing formal triage with an informal prioritisation process carried out by nurses. Topics discussed include whether triage is a bureaucratic process, whether it allows nurses' intuition to be expressed, whether it masks the urgency of the condition of the small number of seriously injured or ill patients, and whether responsibility for decisions on urgency should be separated from responsibility to act on those decisions. It is concluded that managers must consider these questions in the light of arrangements in their own hospital; departmental layout as well as the nursing staff's experience and commitment need to be taken into account.