社区1~3岁儿童语言发育与屏幕暴露的相关性调查研究

目的 分析研究社区1~3岁儿童语言发育与屏幕暴露的相关性,为儿童屏幕暴露现状提供改进意见。方法 选取2016年1月-2018年7月于本院儿童保健门诊随访的1~3岁幼儿共827例,男童406例,女童421例,平均年龄为(24.5±5.3)月。采用自制式调查问卷,由本科保健医生指导调查对象的父母或抚养人现场完成,并结合Gesell 婴幼儿发育量表评估调查对象语言发育情况。结果 827例儿童中,93例诊断为语言发育迟缓,734例语言发育正常。两组儿童接触屏幕年龄段、儿童性别、家庭情况、母亲文化程度、父亲文化程度、母亲年龄、屏幕暴露时间、入睡是否规律、接触屏幕时家长陪同和限制屏幕暴露时间差异均有统计学意义(P＜0.05),控制混杂因素影响后多因素Logistic回归分析结果显示,屏幕暴露时间>2 h(OR=1.687,95%CI:1.022~2.236,P<0.001)、接触屏幕时无家长陪同(OR=2.035,95%CI:1.588~2.634,P=0.002)、未限制屏幕暴露时间(OR=1.475,95%CI:1.087~2.156,P=0.035)为语言发育迟缓的重要危险因素。结论 长时间的屏幕暴露会影响家庭语言环境和儿童睡眠,不利于儿童的语言发育,建议家长禁止小于18月的儿童接触屏幕,大于18月的儿童在家长陪同讲解下接触屏幕,时间控制在2 h以内,严格避免睡觉前观看电子屏幕。     

High-Intensity Interval and Resistance Training Improve Health Outcomes in Older Adults With Coronary Disease

ObjectiveBoth high-intensity interval training (HIIT) and resistance exercises (R) are used in cardiac rehabilitation in patients with coronary artery disease (CAD). However, the combined effect of an HIIT + R exercise program in older adults with CAD is not well investigated. The study's purpose was to assess the changes in anthropometric parameters, physical activity, functional capacity, physiological parameters, and quality of life (QoL) in this population following a combined HIIT + R program.DesignThe study was a 2-group (n = 45 each) randomized controlled single-blinded trial.Setting and ParticipantsThe study was done at a treatment clinic of a tertiary hospital. The mean age of participants was 69.23 ± 4.9 years. The HIIT + R group performed 8 sessions (1/wk) of HIIT + R training. The 30 minutes of the active exercise phase consisted of ten 3-minute bouts. Each bout comprised of 1 minute of high-intensity treadmill walking at 85% to 90% maximum heart rate (MHR), followed by a low-intensity walking at 60%-70% MHR, followed by low-to moderate-intensity resistance training. The Usual Care group underwent conventional medical treatment.MeasuresAnthropometric measurements [weight, body mass index (BMI), waist circumference, body fat percentage, lean body mass], physical activity (International Physical Activity Questionnaire), functional capacity (Incremental Shuttle Walking Test), physiologic measurements (blood pressure, heart rate), and QoL (36-Item Short Form Health Survey) were measured pre- and postintervention.ResultsSignificant group and time interaction were found for the participants in the HIIT + R Group for BMI (P = .001), body fat percentage (P = .001), waist circumference (P < .001), physical activity (P < .001), functional capacity (P < .001), and QoL (P = .001) compared with the UC Group. Significant improvement in systolic blood pressure (P = .001) was seen in the HIIT + R group.Conclusions and ImplicationsA combined HIIT + R training protocol in older adults with CAD can be useful in producing desired health outcomes. Further evaluation of longer duration exercise programs with more frequent dosing needs to be evaluated for their benefits and sustainability.     

运动训练对慢性应激大鼠β—内啡肽分泌的影响

目的：探讨运动训练对慢性应激大鼠β－内啡肽（β－EP）分泌的变化。方法：对大鼠进行为期8周的不同负荷运动训练,并在运动训练后期给予3周的冷刺激,测定大鼠下丘脑和血清中β－EP的含量。结果：（1）经过3周的冷应激后,大鼠产生显著的身心变化,下丘脑和血清β－EP的含量均显著升高,从而表明冷应激可使机体β－ED的合成和释放增多。（2）经过8周的运动训练后,大鼠下丘脑β－EP含量显著升高,血清β－EP含量显著下降;而对运动训练的大鼠施加冷刺激后,大鼠下丘脑和血清中β－EP含量显著低于应激组,以中等负荷运动训练组最为明显。结论：运动训练可以减少内源性β－EP的释放,有效对抗大鼠机体对冷刺激产生的应激反应,维持机体在应激状态下内分泌功能的稳定。     

武警某部女学员有氧耐力训练训练心率的研究

目的为指导和监控部队有氧耐力训练提供参考资料.方法对382名18～22岁女学员依照GJB1337-92和GJB2558-96规定的方法分别测定其安静心率和训练心率.结果安静心率均值为72.85±6.28b/min;按平均年龄21岁计算,中等训练心率为165.76±5.96b/min;最小训练心率为151.17±6.06b/min;最大训练心率为178.23±6.14b/min.结论女学员有氧耐力训练的适宜训练心率为151～178b/min.     

21世纪高级医学人才素质教育及实施的基本途径

（1）目的 探讨21世纪高级医学人才的素质教育及实施的途径。（2）方法 根据21世纪医学和社会发展的需要,分析了21世纪高级医学人才的素质及实施素质教育的基本途径。（3）结果 21世纪高级医学人才要掌握高新技术,拥有广博的知识和坚实的医学基础,具有创新精神和开拓能力,对具体工作具有较强的适应性。转变教育思想,调整新的医学教育课程结构和优化课程内容体系,建立一支适应素质教育需要的师资队伍,创建校园精神文明和营造素质教育氛围是实施素质教育的基本途径。（4）结论 21世纪需要高素质医学人才,转变教育思想和观念,优化课程体系和教学内容、构建新的人才培养模式是实施素质教育的基本途径。     

语感教学:语文教育新视角

语文能力的核心是语言能力,语言能力的培养首先表现在如何提高学生的语感素质。加强语文教育中的语感教学,构建培养语感的教学实践体系,势在必行。     

Natural language processing and entrustable professional activity text feedback in surgery: A machine learning model of resident autonomy

BackgroundEntrustable Professional Activities (EPAs) contain narrative ‘entrustment roadmaps’ designed to describe specific behaviors associated with different entrustment levels. However, these roadmaps were created using expert committee consensus, with little data available for guidance. Analysis of actual EPA assessment narrative comments using natural language processing may enhance our understanding of resident entrustment in actual practice.MethodsAll text comments associated with EPA microassessments at a single institution were combined. EPA—entrustment level pairs (e.g. Gallbladder Disease—Level 1) were identified as documents. Latent Dirichlet Allocation (LDA), a common machine learning algorithm, was used to identify latent topics in the documents associated with a single EPA. These topics were then reviewed for interpretability by human raters.ResultsOver 18 months, 1015 faculty EPA microassessments were collected from 64 faculty for 80 residents. LDA analysis identified topics that mapped 1:1 to EPA entrustment levels (Gammas >0.99). These LDA topics appeared to trend coherently with entrustment levels (words demonstrating high entrustment were consistently found in high entrustment topics, word demonstrating low entrustment were found in low entrustment topics).ConclusionsLDA is capable of identifying topics relevant to progressive surgical entrustment and autonomy in EPA comments. These topics provide insight into key behaviors that drive different level of resident autonomy and may allow for data-driven revision of EPA entrustment maps.     

High-intensity interval training can improve hand grip strength,inspiratory muscle,and quality of life in systemic sclerosis subjects

IntroductionSystemic sclerosis/scleroderma (SSc) is a chronic autoimmune disease with connective tissue, multi-organ, and multisystem involvement. The disease has three main characteristics, namely vasculopathy, fibrosis, and autoimmunity. The effect of high-intensity interval training (HIIT) in aerobic exercise on other rheumatic diseases has been studied, for example in patients with rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA). The purpose of this work is to investigate the effectiveness of HIIT of aerobics exercise on improving the inspiratory muscle, quality of life and functional ability for systemic sclerosis subjects.Material and methodsThe study was conducted on patients with confirmed systemic sclerosis who met the inclusion criteria. The research was carried out for 12 months in the outpatient clinic and gait laboratory of the Department of Physical Medicine and Rehabilitation.ResultsAfter HIIT in aerobic exercise, we found significant changes in inspiratory muscle (SNIP values 45.67 [30.92] vs. 54.25 [22.71]), handgrip (13.14 [4.42] vs. 15.63 [4.08]), walking speed (184.70 [26.86] vs. 246.6 [12.30]), metabolic equivalent (3.53 [0.30] vs. 4.21 [1.25]) and Scleroderma-Specific Health Assessment Questionnaire Disability Index for all visual analog scale (VAS) domains except Disability Index. Exercise approaches are characterized by repeated cycles of exercise interrupted by rest. For a range of clinical conditions, HIIT in aerobic exercise is known to remedy blood vessel function.ConclusionsOur results suggest that HIIT in aerobic exercise has improved functional ability, respiratory muscle strength, and quality of life in SSc subjects. Training twice a week in a 12-week HIIT program is considered to be safe for this population. We have to consider internal and external factors that influenced the result. A larger sample and further exploration of the feasibility of combined exercise in SSc patients should be the focus for future research.     

Digital breast pathology: validation and training for primary digital practice

Digital pathology is a technology which is transforming the way in which breast histopathology specimens are assessed, reported and reviewed. Large scale clinical laboratory deployments of whole slide imaging systems are occurring in diagnostic pathology departments across the world, requiring laboratory and diagnostic staff to navigate new skills and workflows. Transferring from conventional light microscopy assessment of breast specimens to the use of whole slide images (WSI) can be a challenging experience. This article describes an approach to training and validation for breast consultant histopathologists, which has been used and adapted at a number of sites. Examples of types of case that are suitable for training, and some of the potential “pitfalls” of digital reporting for the novice are described, and practical advice regarding clinical digital breast workflow is shared.