区域卫生规划监督和评价框架的构建

区域卫生规划在我国始于20世纪80年代中期，1997年，我国政府公布了发展区域卫生规划的政策以保进该项工作在全国的推广实施。到2001年年底，29个省，市，自治区分布了其省级卫生资源配置标准，然而，对区域卫生规划实施的过程还缺少有关监督与评价的研究。作者试图利用逻辑模型建构区域卫生规划监督与评价的研究，它将包括3个主要部分：短期结构评价，中期结果评价与长期结果评价，每个部分的评价内容再进一步细化，最后对框架特点进行了讨论。     

Comprehensive mitigation framework for concurrent application of multiple clinical practice guidelines

In this work we propose a comprehensive framework based on first-order logic (FOL) for mitigating (identifying and addressing) interactions between multiple clinical practice guidelines (CPGs) applied to a multi-morbid patient while also considering patient preferences related to the prescribed treatment. With this framework we respond to two fundamental challenges associated with clinical decision support: (1) concurrent application of multiple CPGs and (2) incorporation of patient preferences into the decision making process.We significantly expand our earlier research by (1) proposing a revised and improved mitigation-oriented representation of CPGs and secondary medical knowledge for addressing adverse interactions and incorporating patient preferences and (2) introducing a new mitigation algorithm. Specifically, actionable graphs representing CPGs allow for parallel and temporal activities (decisions and actions). Revision operators representing secondary medical knowledge support temporal interactions and complex revisions across multiple actionable graphs. The mitigation algorithm uses the actionable graphs, revision operators and available (and possibly incomplete) patient information represented in FOL. It relies on a depth-first search strategy to find a valid sequence of revisions and uses theorem proving and model finding techniques to identify applicable revision operators and to establish a management scenario for a given patient if one exists. The management scenario defines a safe (interaction-free) and preferred set of activities together with possible patient states. We illustrate the use of our framework with a clinical case study describing two patients who suffer from chronic kidney disease, hypertension, and atrial fibrillation, and who are managed according to CPGs for these diseases.While in this paper we are primarily concerned with the methodological aspects of mitigation, we also briefly discuss a high-level proof of concept implementation of the proposed framework in the form of a clinical decision support system (CDSS). The proposed mitigation CDSS “insulates” clinicians from the complexities of the FOL representations and provides semantically meaningful summaries of mitigation results. Ultimately we plan to implement the mitigation CDSS within our MET (Mobile Emergency Triage) decision support environment.     

中医证候理论内蕴的数学逻辑关系研究——兼论“证素”研究的伪命题特征

通过研究中医证候理论中的数学逻辑关系发现,辨证过程中作为判定证候的3个基本要素的病因（a）、病位（b）、病性（c）和证候（z）之间存在着f（z）=a＋b＋c的数学逻辑关系,证候（z）与症状（zi）之间的数学逻辑关系是f（z）= z1＋z2＋z3＋?＋zi,证候的复杂性体现出的明显特征是症状构成数量的多少。辨证过程中症状与病因、病位和病性以及证候之间的数学逻辑关系式为z1＋z2＋z3＋?＋zi =a＋b＋c= f（z）,但是证候的全集则表现出的是点集拓扑结构的非线性关系。经计算,中医79个主要单一证候共有6.5×105多种不同的存在形式,一定范围内证候群的数量约有6.6×10100个左右,这个超级巨大的数据“古戈尔”可能是中医证候复杂性的根结所在。结果表明,“证素”研究所以运用的贝叶斯网络、神经网络等算法以及双层频权剪叉算法,与证候理论内蕴的数学逻辑关系风马牛不相及,因此“证素”是中医基础理论研究中的伪命题特征,其建立起的以“证素”为核心的辨证方法是“虚构”的,根本不符合中医理论内在规律和临床实际。     

Programmable Bio-Nano-Chip Technology for the Diagnosis of Cardiovascular Disease at the Point-of-Care

Cardiovascular disease remains the leading cause of death in the world and continues to serve as the major contributor to healthcare costs. Likewise, there is an ever-increasing need and demand for novel and more efficient diagnostic tools for the early detection of cardiovascular disease, especially at the point-of-care (POC). This article reviews the programmable bio-nanochip (P-BNC) system, a new medical microdevice approach with the capacity to deliver both high performance and reduced cost. This fully integrated, total analysis system leverages microelectronic components, microfabrication techniques, and nanotechnology to noninvasively measure multiple cardiac biomarkers in complex fluids, such as saliva, while offering diagnostic accuracy equal to laboratory-confined reference methods. This article profiles the P-BNC approach, describes its performance in real-world testing of clinical samples, and summarizes new opportunities for medical microdevices in the field of cardiac diagnostics.     

医用镇痛泵技术新发展及其应用

介绍了局部麻醉用镇痛泵的基本应用和原理,按照其驱动方式和功能介绍了各种类型医用镇痛泵,详细分析了各种镇痛泵的使用指标和优缺点,对医用镇痛泵技术的发展趋势作了简要介绍。     

Optimal locations for MR dampers in civil structures using improved Ant Colony algorithm

This paper studies a design problem concerning installation locations for a number of structural magneto‐rheological (MR) dampers. The mechanical characteristic of each MR damper is functional dependent to an input current, which is regulated by a Fuzzy Logic controller. It is demanded that the chosen arrangement of dampers should change the dynamic response of the structure to meet certain constraints expressed in terms of minimization of an objective function. For this purpose, an improved version of Ant Colony Optimization algorithm is presented. The modified algorithm also utilizes additional heuristic data derivable from a pre‐analysis of the structure in the optimization procedure. Further improvements regarding convergence speed of search algorithm are proposed as well, provided numerical examples study the functionality of the algorithm in different cases. With an acceptable probability from a structural designer's point of view, the proposed method finds qualified solutions during a reasonable number of search iterations. Copyright © 2011 John Wiley & Sons, Ltd.     

The Patient's Perspective: Adherence or Non-adherence to Asthma Controller Therapy?

Study objective. Adherence with controller therapy poses a major challenge to the effective management of persistent asthma. The aim of this study was to explore the patient-related aspects of adherence among adult asthmatics. Design and participants. The participants (n = 509 adult asthmatics), recruited from all parts of Denmark, answered the questionnaire concerning asthma knowledge, attitudes, adherence, and treatment through the Internet. Results. A total of 67% of the patients were prescribed inhaled corticosteroids (ICS). However, according to Global Initiative for Asthma (GINA)-guidelines' symptom severity classification, 85% should have been on ICS. Accidental and intentional non-adherence with ICS at least twice a week was reported by 27% and 24%, respectively. In case of deterioration, 60% of the patients preferred to take more reliever medication, instead of increasing the ICS dose. Having a fixed daily routine with regard to medication and following the advice given by their doctor were the main reasons for adherence, whereas lack of perceived symptoms was the main reason for non-adherence. Non-adherence was associated with increasing disagreement with the statements that controller therapy is effective (p < 0.04), as well as an essential part of asthma therapy (p < 0.002). Conclusions. Both accidental and intentional non-adherence with controller therapy is common among adult asthmatics. The reasons for suboptimal adherence seem to be accessible through education of both patients and caregivers.     

气动逻辑元件在微型呼吸机中的应用

我们将气动逻辑元件原理有机地应用到了微型呼吸机的研制中，并进行了气路集成化设计，使呼吸机具有体积小、重量轻、携带方便、无需电源、安装迅速、操作简单、通气效果确切，并配有简易安全装置等特点，满足了医护工作者在现场急救及重症患者后送途中呼吸支持的需要。     

墨家与亚里士多德谬误论比较研究

谬误论是逻辑学的重要内容。中国古代的墨家和古希腊的亚里士多德 ,分别对谬误论进行了各具特色的研究。其相同点是墨家和亚氏都分析了思维形式方面的谬误、都重视对语言和违反矛盾律所犯逻辑谬误的分析。其不同点是墨家和亚氏对谬误分析的表现形式不同 ,以及其谬误理论的系统化程度不同。墨家逻辑和亚氏逻辑是本质相同而形态不同的两种谬误理论。由于人类思维规律在本质上是一致的 ,因而 ,它们所形成谬误论的本质也是相同的。但又由于它们的谬误论形成的具体条件不同 ,如当时中西方论辩形式不同、逻辑体系不同、语言风格不同 ,谬误论的内容和形式也就不同。它们各具特色 ,在当时都对反驳诡辩、认识真理起了巨大的作用。比较墨家与亚氏的谬误论 ,认识其同异和发生发展规律 ,是中西逻辑史研究的一个重要课题。     

基于正交函数的双线性系统预测控制器设计方法

基于离散脉冲正交函数及其性质,建立了一种新的附加系统方法,以实现双线性系统的预测控制方案。这种设计方法避免了非线性优化问题,所有的运算均为代数计算,使设计过程得以简化。对合成氨反应器仿真结果,证明了本法的有效性。