医疗健康领域问题分类探析

目的/意义 梳理分析医疗健康领域问题分类发展现状,为提升医学问答系统性能提供思路。方法/过程 基于医疗健康领域问题分类相关文献资料,梳理现有分类体系、数据集、深度学习方法、评价标准和应用情况,分析未来医疗健康问题分类研究改进方向和核心科学问题。结果/结论 医疗健康问题分类有助于更好地理解问题,提高医疗健康领域问答系统性能,提供更高效的医疗服务。     

Determination of Heat Transfer Coefficient for Air-Atomized Water Spray Cooling and Its Application in Modeling of Thermomechanical Controlled Processing of Die Forgings

The paper presents the method and results of determination of heat transfer coefficient for air-atomized water spray cooling with consideration of infrastructural factors of industrial cooling conveyor, such as effect of accelerated air. The established values of heat transfer coefficient were implemented into a numerical model of cooling line, with special definition of sprayers and the movement of the part subjected to quenching. After quantitative validation on selected samples, the obtained coefficients were used for the solution of the technological problem by means of localized cooling rate enhancement, which forms a case study confirming reliability of the established water spray heat transfer functions and suitability of the determined models for design of thermomechanical controlled processing of complex-geometry parts.     

The 25-Item Ontario Child Health Study Emotional Behavioural Scales-Brief Version (OCHS-EBS-B): Test-Retest Reliability and Construct Validity When Used as Categorical Measures

ObjectiveChild and youth mental health problems are often assessed by parent self-completed checklists that produce dimensional scale scores. When converted to binary ratings of disorder, little is known about their psychometric properties in relation to classifications based on lay-administered structured diagnostic interviews. In addition to estimating agreement, our objective is to test for statistical equivalence in the test-retest reliability and construct validity of two instruments used to classify child emotional, behavioural, and attentional disorders: the 25-item, parent completed Ontario Child Health Study Emotional Behavioural Scales-Brief Version (OCHS-EBS-B) and the Mini International Neuropsychiatric Interview for Children and Adolescents-parent version (MINI-KID-P).MethodsThis study draws on independent samples (n = 452) and uses the confidence interval approach to test for statistical equivalence. Reliability is based on kappa (κ). Construct validity is based on standardized beta coefficients (β) estimated in structural equation models.ResultsThe average differences between the MINI-KID-P and OCHS-EBS-B in κ and β were −0.022 and −0.020, respectively. However, in both instances, criteria for statistical equivalence were met in only 5 of 12 comparisons. Based on κ, between-instrument agreement on the classifications of disorder went from 0.481 (attentional disorder) to 0.721 (emotional disorder) but were substantially higher (0.731 to 0.895, respectively) when corrected for attenuation due to measurement error.ConclusionsAlthough falling short of equivalence, the results suggest on balance that the reliability and validity of the two instruments for classifying child psychiatric disorder assessed by parents are highly comparable. This conclusion is supported by the high levels of agreement between the instruments after correcting for attenuation due to measurement error.     

医院护理人力资源配置中存在的问题及对策

通过分析目前我国护理人力资源配置的现状，发现存在的主要问题有：医院护理人力资源配置可参考的标准陈旧；医院护理人员数量不足；医院护理人员年龄结构过于年轻化；医院护理人员学历层次偏低；医院护理人员职称结构不合理，中高职称比例低；医院护理人员流失大等。对策：建议修订配置标准；适当增加医院临床护士数量；提高现有护理人力资源利用率；加强护士的在职培训和学校教育；规范护理技术职称的评审，保持护理队伍合理的技术职称结构。     

依托科学基金促进高校青年科技人才快速成长

本文分析了我校医科35岁以下青年科技人才面临的现状,他们申报、承担的以资助基础研究为主的科学基金的相关情况,探讨了科学基金对他们资助和培养中存在的问题,提出了青年科学人才适应科学基金发展要求以促进自身成长等建议.     

问题管理模式在外籍患者跨文化护理中的应用

目的探讨问题管理模式对提高外籍患者跨文化护理质量的作用。方法采用自行设计的"护理外籍患者面临的困难问题"调查问卷,对上海市2所综合性医院的60名护士进行调查,同时应用"外籍患者跨文化护理需求及评价问卷"对256例外籍患者进行调查。针对存在的共性问题,如护士语言交流障碍、隐私保护不够、宗教信仰知识缺乏、饮食习惯不了解、尊重风俗禁忌不够、社交礼仪不了解、跨文化护理理论知识缺乏7个问题,对护士实施跨文化护理问题管理措施干预,包括跨文化护理理论知识系列培训、保护隐私制度及尊重宗教信仰实施细则等规范的实施、跨文化护理质量监控及预警等,进行为期1年的培训及管理干预。干预后再次抽取198例外籍患者进行调查。结果干预后护士护理外籍患者面临的困难问题显著少于干预前,护理外籍患者案例考核评分显著高于干预前(P0.05,P0.01);干预后外籍患者对跨文化护理服务存在的问题显著少于干预前,对护理服务满意度评分显著高于干预前(P0.05,P0.01)。结论问题管理模式在外籍患者跨文化护理管理中的应用,可有效提高患者的满意度及跨文化护理的服务质量。     

退变性腰椎侧凸长节段融合术后远端交界性问题分析

目的 :探讨退变性腰椎侧凸(degenerative lumbar scoliosis,DLS)长节段固定融合术后远端交界性问题(distal junctional problem,DJP)的发生率、危险因素及对患者生活质量的影响。方法 :2009年4月～2017年10月在我院确诊为DLS、年龄≥40岁、行长节段(≥4个节段)固定融合手术、随访时间≥1年的患者132例,将随访时出现DJP的13例患者纳入DJP组,未出现任何机械性并发症的41例患者纳入对照组。对个体因素[手术时的年龄、性别、体重指数(body mass index,BMI)、骨密度(bone mineral density,BMD)和T值、合并糖尿病和高血压情况、美国麻醉医师学会(ASA)分级等因素]、手术因素[固定融合节段数、远端固定椎(lowest instumented vertebra,LIV)位置、截骨操作和椎间融合情况]以及术前和术后影像学参数[侧凸Cobb角、顶椎的旋转程度(Nash-Moe)、顶椎偏移距离(apical vertebral translation,AVT)、冠状位平衡(coronal vertical axis,CVA)、胸椎后凸角(thoracic kyphosis,TK)、胸腰段后凸角(thoracolumbar kyphosis,TLK)、腰椎前凸角(lumbar lordosis,LL)、骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacral slope,SS)、矢状位平衡(sagittal vertical axis,SVA)、T1骨盆角(T1 pelvic angle,TPA)、躯干整体倾斜角(global tilt,GT)等]进行单变量和多变量分析。比较两组术前和随访时的腰痛视觉模拟(visual analog scale,VAS)评分、下肢痛VAS评分、Oswestry功能障碍指数(Oswestry disability index,ODI)、日本骨科学会(Japanese Orthopaedic Association,JOA)-29评分、脊柱研究学会(Scoliosis Research Society-22,SRS-22)评分和健康状况调查简表(short form 36 health survey questionnaire,SF-36)评分。结果 :本组患者DJP的发生率为9.8%(13/132),其中6例(46.2%)患者进行了翻修手术。DJP组患者骨密度T值显著低于对照组,DJP患者骨量减少及骨质疏松的比例显著高于对照组(P0.05),其他个体因素无显著性差异。两组手术因素均无显著性差异。与对照组相比,DJP组患者术前TLK较大、PT较小、SVA70mm的比例较高(53.85%vs 19.51%,P=0.040);术后即刻TLK、SVA显著大于对照组,矢状位失衡患者比例显著高于对照组(46.15%vs 14.63%,P=0.046),其他影像学参数无显著性差异。Logistic回归分析提示骨质疏松(OR=8.90,95%CI=1.95～40.51,P=0.005)、术后即刻矢状位失衡(OR=5.82,95%CI=1.15～29.42,P=0.033)发生DJP的风险分别增加了7.9倍、4.8倍。两组患者术前各项健康相关生活质量评分均无统计学差异;对照组患者术后各项健康相关生活质量评分较术前均有显著性提高(P0.05),而DJP组患者ODI、JOA评分、SF-36精神健康较术前无明显提高(P0.05);与对照组比较,DJP组随访时腰痛VAS评分、ODI、JOA评分、SRS疼痛、SRS功能状况、SRS亚总分、SRS治疗满意度、SF-36生理健康评分、SF-36精神健康评分更差。结论:DLS长节段固定融合术后9.8%的患者发生了远端交界性问题,严重影响患者术后生活质量改善;骨质疏松和术后即刻矢状位失衡是发生DJP的独立危险因素。     

父母迁移模式对农村留守儿童问题行为的影响

农村留守儿童是问题行为的高发群体,在不同父母迁移模式下,留守儿童在问题行为表现上存在差异.通过综述近年来农村留守儿童问题行为的研究,发现相较于非留守儿童,父母均迁移儿童的问题行为总体发生率显著较高;在父亲或母亲一方迁移情况下,母亲迁移儿童的问题行为发生率显著高于父亲迁移.本综述为进一步深入研究农村留守儿童问题行为提供参...     

An Inverse Analysis for Establishing the Temperature-Dependent Thermal Conductivity of a Melt-Cast Explosive across the Whole Solidification Process

Thermal conductivity is one of the most important thermophysical properties of a melt-cast explosive. However, the temperature-dependent thermal conductivity of such explosives cannot be easily measured across the whole solidification process (including the liquid, semi-solid, and solid states). This study used an inverse analysis method to estimate the temperature-dependent thermal conductivity of a 2,4-dinitroanisole/cyclotetramethylenetetranitramine (DNAN/HMX) melt-cast explosive in a continuous way. The method that was used is described here in detail, and it is verified by comparing the estimated thermal conductivity with a prespecified value using simulated measurement temperatures, thereby demonstrating its effectiveness. Combining this method with experimentally measured temperatures, the temperature-dependent thermal conductivity of the DNAN/HMX melt-cast explosive was obtained. Some measured thermal conductivity values for this explosive in the solid state were used for further validation.