非招标采购方式的问题

在军队物资非招标采购方式运用实践中,竞争性谈判采购存在竞争性程度问题、谈判操作中的严密性问题、临时更改评审方法标准和成交条件问题;询价采购存在评审方法和评定成交的标准问题、是否必须有3家以上合格报价问题、指定品牌问题和其他程序问题;单一来源采购存在价格居高不下问题、成本价格随性能同时增长问题、技术创新与技术改造的动力受限问题.     

Does physical exercise improve obstacle negotiation in the elderly? A systematic review

BackgroundPhysical exercise improves walking in the elderly but much less is known about its effect on more challenged gait, such as obstacle negotiation. We conducted a systematic review to discuss the effects of regular physical exercise on kinematics and kinetics of obstacle negotiation in the elderly.MethodsA comprehensive literature search revealed 859 citations for review, whereof 206 studies entered the full-text analysis. After application of inclusion and exclusion criteria, 13 studies were included in this systematic review.FindingsMost of them presented a reasonable quality (average 0.68) but none of them reached the level of a randomized control trial. Interventions were heterogeneous, with training periods lasting from 5 days to 10 months. Studies assessed obstacle negotiation basically considering 3 types of testing paradigm, namely a walkway with either a single obstacle crossing, or with multiple obstacles, or else a treadmill with an obstacle avoidance task under time pressure.InterpretationIn general, longer training programs had better results and very short ones were not effective. A weekly frequency of 2–3 times was the most common among the studies showing positive effects. Regardless of exercises types performed, most of them were effective and so far, there is no consensus about the best exercise for improving obstacle negotiation. A lack of studies on this topic still is evident. Including a record of fall score can further help in deciding which programs are to be preferred.     

Development of Innovative Contra-angle Handpiece Device with Piston Movement for Root Canal Preparation

IntroductionThe purpose of this study was to assess the optimal amplitude and weight of the newly developed contra-angle handpiece. The handpiece uses piston movement without using an endodontic motor and enables a safe, quick, and reliable canal preparation.MethodsA prototype handpiece was designed. Instrumentation was performed on root canal resin blocks by 20 operators in 3 groups: the prototype handpiece with an H file (a stainless steel #25 manual H file, the piston group), a manually standardized technique with a K file (stainless steel #15–25 K files, the manual group), and a nickel-titanium (NiTi) reciprocating file with an endodontic motor (Reciproc Blue R25 [VDW, Munich, Germany], the NiTi group). Transportation of the canal center line and the time required for preparation were measured and statistically analyzed.ResultsThe optimal condition was an amplitude of 1.35 mm and a weight of 61.0 g. Transportation of the canal center was observed in all groups. A statistically significant difference was found at 2.0–3.0 mm from the apical foramen between the piston or NiTi group and the manual group, but no significant difference was found between the piston and NiTi groups. The least transportation was found in the NiTi and piston groups. The handpiece with a #25 H file demonstrated a good centering ability, similar to the NiTi file, which enabled speedy preparation. The time required for preparation between the piston or NiTi group and the manual group was statistically different. No significant difference was observed between the piston and NiTi groups (P < .05).ConclusionsWe concluded that the newly designed handpiece achieved efficient canal preparation and negotiation. The handpiece could avoid endodontic accidents, including ledge formation, instrument separation, and perforation.     

The relationship between lower body strength and obstructed gait in community-dwelling older adults

OBJECTIVES: To determine the relationship between lower body strength of community-dwelling older adults and the time to negotiate obstructed gait tasks. DESIGN: A correlational study. SETTING: The Biomechanics Laboratory, Deakin University, Australia. PARTICIPANTS: Twenty-nine women and 16 men aged 62 to 88 were recruited using advertisements placed in local newspapers. The participants were independent community dwellers, healthy and functionally mobile. MEASUREMENTS: Maximal isometric strength of the knee extensors and dynamic strength of the hip extensors, hip flexors, hip adductors, hip abductors, knee extensors, knee flexors, and ankle plantar flexors were assessed. The times to negotiate four obstructed gait tasks at three progressively challenging levels on an obstacle course and to complete the course were recorded. The relationship between strength and the crossing times was explored using linear regression models. RESULTS: Significant associations between the seven strength measures and the times to negotiate each gait task and to walk the entire course at each level were obtained (r = -0.38 to -0.55; P < .05). In addition, the percentage of the variance explained by strength (R(2)), consistently increased as a function of the progressively challenging level. This increase was particularly marked for the stepping over task (R(2) = 19.3%, 25.0%, and 27.2%, for levels 1, 2, and 3, respectively) and the raised surface condition (R2 = 17.1%, 21.1%, and 30.8%, for levels 1, 2, and 3, respectively). CONCLUSION: The findings of the study showed that strength is a critical requirement for obstructed locomotion. That the magnitude of the association increased as a function of the challenging levels suggests that intervention programs aimed at improving strength would potentially be effective in helping community-dwelling older adults negotiate environmental gait challenges.     

Complex obstacle negotiation exercise can prevent falls in community‐dwelling elderly Japanese aged 75 years and older

Objectives: The aim of the present study was to evaluate whether a complex course obstacle negotiation exercise (CC), a 24‐week exercise program, can reduce falls and fractures in older adults, as compared with a simple course obstacle negotiation exercise (SC). Methods: This trial was carried out on older adults, aged 75 years and above in Japan. In total, 157 participants were randomized into the CC group (n = 78) and the SC group (n = 79). Participants were enrolled in the exercise class using the CC program or the SC program for 24 weeks. The outcome measure was the number of falls and fracture rates in CC and SC groups for 12 months after the completion of the 24‐week exercise class. Results: Two participants (2.8%) in the CC group and 19 (26.0%) in the SC group experienced falls during 12 months. During the 12‐month follow‐up period after the intervention, the incidence rate ratio (IRR) of falls in the SC group against the CC group was 9.37 (95% CI = 2.26–38.77). One participant (1.4%) in the CC group and eight (10.9%) in the SC group had experienced fractures during 12 months after the exercise class. The IRR of fractures in the SC group compared with the CC group was 7.89 (95% CI = 1.01–61.49). Conclusions: The results of the present trial show that the participants who received individualized obstacle avoidance training under complex tasks combined with a traditional intervention had a lower incidence rate of falls and fractures during the 12 months after the intervention. Geriatr Gerontol Int 2012; 12: 461–467.     

Informal caregivers’ views on the division of responsibilities between themselves and professionals: A scoping review

This scoping review focuses on the views of informal caregivers regarding the division of care responsibilities between citizens, governments and professionals and the question of to what extent professionals take these views into account during collaboration with them. In Europe, the normative discourse on informal care has changed. Retreating governments and decreasing residential care increase the need to enhance the collaboration between informal caregivers and professionals. Professionals are assumed to adequately address the needs and wishes of informal caregivers, but little is known about informal caregivers’ views on the division of care responsibilities. We performed a scoping review and searched for relevant studies published between 2000 and September 1, 2016 in seven databases. Thirteen papers were included, all published in Western countries. Most included papers described research with a qualitative research design. Based on the opinion of informal caregivers, we conclude that professionals do not seem to explicitly take into account the views of informal caregivers about the division of responsibilities during their collaboration with them. Roles of the informal caregivers and professionals are not always discussed and the division of responsibilities sometimes seems unclear. Acknowledging the role and expertise of informal caregivers seems to facilitate good collaboration, as well as attitudes such as professionals being open and honest, proactive and compassionate. Inflexible structures and services hinder good collaboration. Asking informal caregivers what their opinion is about the division of responsibilities could improve clarity about the care that is given by both informal caregivers and professionals and could improve their collaboration. Educational programs in social work, health and allied health professions should put more emphasis on this specific characteristic of collaboration.