分级诊疗背景下基层医疗卫生机构基本医疗服务绩效考核指标体系探讨

目的 在分级诊疗的背景下,尝试建立一套客观、合理的基层医疗卫生机构基本医疗服务绩效考核指标体系,为政府的监管考核提供参考。方法 在查阅相关卫生政策和大量文献的基础上,采用两轮德尔菲专家咨询法、界值法确定绩效考核指标,利用专家打分法和乘积法确定指标权重,形成基层医疗卫生机构基本医疗服务绩效考核指标体系。结果 构建了一套基层医疗卫生机构基本医疗服务绩效考核指标体系。一级指标3个,分别为医疗服务数量与效率、医疗服务质量与安全、医疗费用,其权重为0.328 1、0.344 3、0.327 7,二级指标21个。结论 客观、合理的绩效考核指标体系有利于激发基层医疗卫生机构医务人员的积极性,提升医疗服务能力,切实推进分级诊疗,最终达到提高人民健康水平的目的。     

中国乙型肝炎病毒基因组序列突变及进化分析

目的 了解中国乙型肝炎病毒（hepatitis B virus,HBV）基因组序列的免疫逃逸突变、耐药突变和基因组进化信息。方法 选取1998-2021年在GenBank中的中国HBV全基因组序列信息作为分析对象,采用MAFFT软件进行聚类分析,使用在线工具Gen2pheno进行免疫逃逸突变和耐药突变分析,使用BEAST 1.10.4做序列的时间进化分析。结果 5 426条序列纳入分析集,分布于我国19个省份,C型占比最高（59.1%,3 211/5 426）。其次为B型（33.7%,1 833/5 426）。有764条（14.1%,764/5 426）序列发生了免疫逃逸突变,98.1%的序列至少发生了1处反转录酶编码区域突变。中国大部分系列的进化根在公元1801年左右。结论 中国HBV耐药突变率较高,HBV基因组进化缓慢。     

Functional mutations of SARS-CoV-2: implications to viral transmission,pathogenicity and immune escape

The pandemic of coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to major public health challenges globally. The increasing viral lineages identified indicate that the SARS-CoV-2 genome is evolving at a rapid rate. Viral genomic mutations may cause antigenic drift or shift, which are important ways by which SARS-CoV-2 escapes the human immune system and changes its transmissibility and virulence. Herein, we summarize the functional mutations in SARS-CoV-2 genomes to characterize its adaptive evolution to inform the development of vaccination, treatment as well as control and intervention measures.     

Gregor Johann Mendel and Modern Evolutionary Biology: Mendel and Darwin

Evolution by natural selection is an explicitly genetic theory. Darwin recognized that a working theory of inheritance was central to his theory and spent much of his scientific life seeking one. The seeds of his attempt to fill this gap, his “provisional hypothesis” of pangenesis, appear in his notebooks when he was first formulating his evolutionary ideas. Darwin, in short, desperately needed Mendel. In this paper, we set Mendel’s work in the context of experimental biology and animal/plant breeding of the period and review both the well-known story of possible contact between Mendel and Darwin and the actual contact between their ideas after their deaths. Mendel’s contributions to evolutionary biology were fortuitous. Regardless, it is Mendel’s work that completed Darwin’s theory. The modern theory based on the marriage between Mendel’s and Darwin’s ideas as forged most comprehensively by R. A. Fisher is both Darwin’s achievement and Mendel’s.     

Hemagglutinin Subtype Specificity and Mechanisms of Highly Pathogenic Avian Influenza Virus Genesis

Highly Pathogenic Avian Influenza Viruses (HPAIVs) arise from low pathogenic precursors following spillover from wild waterfowl into poultry populations. The main virulence determinant of HPAIVs is the presence of a multi-basic cleavage site (MBCS) in the hemagglutinin (HA) glycoprotein. The MBCS allows for HA cleavage and, consequently, activation by ubiquitous proteases, which results in systemic dissemination in terrestrial poultry. Since 1959, 51 independent MBCS acquisition events have been documented, virtually all in HA from the H5 and H7 subtypes. In the present article, data from natural LPAIV to HPAIV conversions and experimental in vitro and in vivo studies were reviewed in order to compile recent advances in understanding HA cleavage efficiency, protease usage, and MBCS acquisition mechanisms. Finally, recent hypotheses that might explain the unique predisposition of the H5 and H7 HA sequences to obtain an MBCS in nature are discussed.     

Insights into Genetic Characteristics and Virological Features of Endemic Avian Influenza A (H9N2) Viruses in Egypt from 2017–2021

From 2010 to 2013, genotype I avian influenza A(H9N2) viruses of the G1-lineage were isolated from several poultry species in Egypt. In 2014, novel reassortant H9N2 viruses were detected in pigeons designated as genotype II. To monitor the subsequent genetic evolution of Egyptian A(H9N2) viruses, we characterized the full genomes of 173 viruses isolated through active surveillance from 2017 to 2022. In addition, we compared the virological characteristics and pathogenicity of representative viruses. Phylogenetic analysis of the HA indicated that all studied sequences from 2017–2021 were grouped into G1-like H9N2 viruses previously detected in Egypt. Phylogenetic analysis indicated that the Egyptian A(H9N2) viruses had undergone further reassortment, inheriting four genes (PB2, PB1, PA, NS) from genotype II, with their remaining segments deriving from genotype I viruses (these viruses designated as genotype III). Studying the virological features of the two most dominant genotypes (I and III) of Egyptian H9N2 viruses in vitro and in vivo indicated that both replicated well in mammalian cells, but did not show any clinical signs in chickens, ducks, and mice. Monitoring avian influenza viruses through surveillance programs and understanding the genetic and antigenic characteristics of circulating H9N2 viruses are essential for risk assessment and influenza pandemic preparedness.     

一种求解阻塞流水车间多目标调度的离散差分进化算法

针对流水车间中产品不存在缓冲区的多目标优化问题,研究了阻塞流水车间的最大完工时间和总流程时间的最小化问题,提出了一种多目标离散差分进化（Multi-objective Discrete Differential Evolution,MDDE）算法搜索Pareto最优调度解。MDDE的变异个体通过非支配解或当前解的邻域随机产生,实验个体通过交叉操作产生,而选择过程则设计为一种多目标选择策略。此外,算法还混合了一种基于插入的Pareto局部搜索方法。基于标准测试算例的数值仿真实验表明,MDDE算法获得的非支配解集在Inverted Generational Distance、Set Coverage和Hypervolume性能指标上均有较好的表现。     

从澳大利亚护理实践的演变看中国社区护理的发展(二)——中国社区护理的发展和挑战

目的从历史纵深角度,探讨我国护理的发展沿革及社区护理面临的严峻挑战,揭示阻碍社区护理发展的历史和文化渊源,从而为制定发展社区护理的政策,迎接老龄化社区卫生服务挑战,提供有意义的依据。方法以文献研究和政策分析作为主要的研究手段。结果中国的护士源于鸦片战争后医学传教士带来的西医技术医学体系,从传统的家庭护理一步跨入医院为中心的护理。然而机构内护理与东方文化传统的矛盾,医护比例的严重倒置,以及护理培训制度不健全,不但影响了医院护理质量,也使得社区护理资源奇缺。社区护理教育边缘化和人力发展严重滞后,是困扰我国社区卫生服务发展的主要障碍。结论大力发展社区护理是保证社区协调发展和满足人群健康需要的关键战略。我国的社区护理发展与其他国家一样,受到历史传承因素的影响,面临迅速增长的社区需要与发育不良的社区护理之间的矛盾,医学界和政府都应该从历史和文化的角度理解这个问题的背景,并从中获得启迪。     

金属雕塑的历史沿革

人类进入文明社会之际 ,硬度远远高于陶器的青铜器 ,有力地促进了人类的文明进程。铁器的出现和广泛使用 ,极大地促进了社会生产力的发展 ,导致封建社会的建立和奴隶制社会的崩溃。大工业革命的历史巨轮隆隆行驶在用新的金属材质“钢”制成的轨迹上 ,崭新的历史纪元伴随日新月异的现代科学技术的急速发展 ,不断为人类拓展着新的生活空间 ,金属在人类历史上所起的重要作用 ,超越了艺术的领域 ,甚至成为人类社会文明进步的一种标识。