投影遗传算法

针对一般遗传算法在求解优化问题的多个优化解时的局限性,结合曲面投影与遗传算法的基本思想,提出了一种基于曲面投影的投影遗传算法用于解决此类问题,数值验证的结果表明了本算法的有效性和实用性。     

胰腺癌侵犯胰周结构的CT评价

目的探讨胰腺癌的CT诊断价值.方法对76例胰腺癌的CT表现进行分析并与手术病理结果对照.结果①胰腺癌在CT上表现为低密度的肿块,不强化或强化不明显,肿块边缘不规则强化;②胰头癌可引起胆总管、胰管的扩张;③胰腺癌多伴邻近血管及脏器受侵.结论 CT能正确评价胰腺癌及胰周浸润,是判断胰腺癌能否手术切除的重要检查手段.     

A hospital pioneers reform of its state's procurement code

In today's changing healthcare marketplace, hospitals across the US are rapidly moving toward developing integrated healthcare delivery networks. In addition, the emergence of managed care and the growing trend toward capitation have compelled hospitals to reduce costs in response to these changes. Moreover, this impetus to provide quality care at reduced cost has affected the purchasing behavior of many hospitals, forcing material managers to pursue innovative procurement methods. This article describes how the Medical University of South Carolina (MUSC) Medical Center, (Charleston, SC) obtained significant savings in purchasing as a result of pioneering legislative reforms in the procurement process.     

Statistical process control and direct care staff performance

A state-operated residential facility has for the past five years been using performance feedback as the primary method for improving direct care staff interactions with clients. The major problem with this approach is determining when staff performance is significantly above or below average. Statistical process control charts are being used to determine whether variations in staff performance are the result of common or special causes. Analysis of staff performance for one year suggests that variation in staff performance may be due to special causes, such as the characteristics of the clients served and the type of service that is provided to these clients. Services were adapted to the characteristics of these clients, which improved staff performance and reduced variation.     

A COMPARATIVE STUDY OF TENIDAP, A CYTOKINE-MODULATING ANTI-RHEUMATIC DRUG, AND DICLOFENAC IN RHEUMATOID ARTHRITIS: A 24-WEEK ANALYSIS OF A 1-YEAR CLINICAL TRIAL

Tenidap is a novel anti-rheumatic drug that combines cytokinemodulation with cyclo-oxygenase inhibition. This 24-week, multicentre,double-blind, randomized study compared the clinical efficacy,biochemical effects and safety of tenidap 120 mg/day (once daily)with diclofenac 150 mg/day (50 mg t.i.d.) in the treatment of384 patients with active rheumatoid arthritis. After 24 weeks,improvement with tenidap was significantly greater than withdiclofenac for all five primary efficacy parameters, two ofthe four secondary efficacy parameters and 11 of the 13 ArthritisImpact Measurement Scales assessments. The superior efficacyof tenidap was apparent after 4 weeks of treatment with furtherimprovements observed by 24 weeks. The probability of discontinuationdue to lack of efficacy was significantly greater in the diclofenacgroup. Tenidap but not diclofenac was associated with significant,rapid and sustained reductions in C-reactive protein and serumamyloid A levels and with a significant reduction in plasmainterleukin-6. The nature and frequency of side-effects weresimilar in the two groups as was the discontinuation rate fortreatment-related safety reasons. Tenidap was associated withan equal incidence of elevated transaminases, but a higher incidenceof mild (     

A comparison of augmenting central serotonin and noradrenaline function in healthy subjects: implications for studies on the neurochemistry of anxiety

Biochemical and psychophysiological effects of augmenting serotonergic and noradrenergic function were compared in 12 normal volunteers. Fluvoxamine (100 mg), a serotonin (5-HT) re-uptake inhibitor, maprotiline (75 mg), a noradrenaline re-uptake inhibitor, and placebo were given for 7 days each to each subject. Subjects were tested pre-drug on days 1, 4 and 8 of each treatment. Catecholamines in 24 h urine, 'platelet-rich' plasma 5-HT and hormones, EEG, auditory evoked response, skin conductance, and bodily and psychological responses were monitored. Augmentation of central 5-HT by fluvoxamine was demonstrated by the decrease of 5-HT plasma levels. Fluvoxamine also reduced urinary dopamine, indicating a decrease in dopamine metabolism in response to augmentation of 5-HT function. Decrease in pulse rate, loss of appetite and a mild arousing effect were also detected with administration of fluvoxamine. Thus, further investigations on the neuro chemistry of anxiety disorders should include the study of mechanisms of interaction of neurotransmitters.     

Maintaining patient satisfaction in a hospital reorganization

A review of inpatient satisfaction data for MUSC provides both comfort and cause for additional study. Although overall satisfaction rates of 89 and 88 during the period of organizational change indicate stable patient perceptions, one must reflect upon these scores in greater detail. For example, although survey response rates in the 36 percent to 28 percent range appear customary for this type of survey, absolute numbers of discharge responses averaged 496 for the four quarters reported. Some confidence can be taken in the fact that overall survey scores were highly consistent in the 89 to 88 range for the entire reporting period. Moreover, the fact that workforce performance variables such as medication errors and patient occurrence reports did not change indicates that patient care did not deteriorate during this period. Although one could argue that in a time of workforce reduction, employees may work more diligently in order to ensure job security, and that work deterioration may be more apparent over a longer period of observation, this limited view suggests that, at least in the acute phase, work performance was maintained. Future studies should review the relative effectiveness of the specific strategies adopted by MUSC management to ensure high levels of patient care. For example, although MUSC adopted a fairly comprehensive communications effort, it is difficult to discern whether timeliness, variety, or repetition contributed more to the effectiveness of the communications program. Such information could help managers develop focused change implementation strategies. It appears from the inpatient survey data collected by UHC and from the two work performance monitors that MUSC's approach to change management has been able to preserve acceptable levels of patient satisfaction in the face of significant organizational change. Furthermore, these strategies may have been helpful in countering the turbulence caused by large scale change or, at the very least, insulating the care site from potentially negative effects.     

Anthropometric Characteristics of Mohawk Children Aged 6 to 11 Years: A Population Perspective

OBJECTIVE: Recent studies have concluded that Native North American children have higher proportions of overweight and obesity than children from the general North American population. This study presents anthropometric data on a representative sample of children from the Mohawk Nation that can be used for comparison with other Native American populations. DESIGN: This is a cross-sectional study comparing distributions of anthropometric characteristics of Mohawk children to the corresponding age and gender data from the Second National Health and Nutrition Examination Survey (NHANES II). Weight, height, triceps and subscapular skinfold thickness, and waist and hip circumferences were measured in 527 children. SUBJECTS/SETTING: All children in grades 1 to 6 (aged 6 to 11 years) in the 3 elementary schools of 2 Mohawk communities in Canada, for whom parental consent was obtained, were enrolled in the present study. There were no exclusion criteria. With a participation rate of 83%, the 527 children enrolled in this study represent an unbiased sample of the population from 2 Mohawk territories. RESULTS: Compared with children studied in NHANES II, Mohawk children were similar in height and triceps skinfolds but were generally heavier, had thicker subscapular skinfolds, and had greater waist and hip circumferences. These differences were greater in older children. Mohawk children who had extreme-high weight values compared with their population means were heavier than their NHANES II counterparts. APPLICATIONS/CONCLUSIONS: Results indicated that, on average, Mohawk children seem to be slightly heavier than children in NHANES II. Except for those with extreme overweight values, Mohawk children show less variation of weight and body mass index than children in NHANES II. Finally, overweight Mohawk children seem to be more likely to carry their excess body fat truncally, compared with overweight children from NHANES II. Health practitioners working with Native American populations should be careful when assessing childhood obesity. Simple comparisons of weight or body mass index with NHANES standards may lead to inappropriate risk assessments.     

Salient factors influencing resident advisor turnover: An exploratory study

Child care workers have been in the forefront of using their expertise in planning and staffing Community Living Arrangements (e.g., small group homes and apartments) for mentally retarded children and adults. Unfortunately, many child care workers who entered the field of Resident Advisorship (e.g., houseparents) with enthusiasm have voluntarily left after a short period of time. This study examines the results of several open-ended interviews with Resident Advisors working in apartment-based Community Living Arrangements for the mildly and moderately retarded. These interviews were conducted to identify those factors they perceived as sources of job satisfaction and dissatisfaction, contributing to employment longevity. Herzberg's formulations regarding the attractiveness of employment are presented as a logical way of interpreting the data.     

Fashionable pride: an ageless concern

Because of the large number of young men who had either been killed in the Civil War, left the region seeking a new beginning in the West, or moved to more prosperous metropolitan centers on the East coast, rural life in 19th century New England was primarily matriarchal or female-centered. As evidenced in the works of the "local color" writers--Harriet Beecher Stowe, Rose Terry Cooke, Elizabeth Stuart Phelps Ward, Sarah Orne Jewett, and Mary E. Wilkins Freeman--the women who remained were, for the most part, poor, elderly, and impoverished, living in a land where, for them, scarcity was the norm. They were what has come to be known as the "rural poor." Nonetheless, even though most of the pleasures in life were beyond their reach, these New England women took great pride in what little they had and put great stock in a particular dress, bonnet, or tea service that enabled them to maintain a sense of dignity and decorum in the face of great adversity. Continuing to dress well, serving an elegant tea, wearing the proper bonnet, allowed them to live their lives with their heads held high and to carry on as the strong, indomitable women they were.