东北地区2000～2005年住院军事飞行人员疾病构成和常见病疾病谱调查

目的 探讨东北地区2000～2005年住院军事飞行人员疾病的发生、发展与分布规律,为完善新时期飞行人员疾病预防、诊治和医学鉴定提供客观依据. 方法 采用流行病学回顾性调查方法 ,统计分析东北地区2000～2005年2223人次住院军事飞行人员的病例资料,并按国际疾病分类法第9版(ICD-9)编制"东北地区2000～2005年军事飞行人员疾病构成"和"东北地区2000～2005年军事飞行人员常见病疾病谱".应用SPSS 10.0统计软件进行统计分析. 结果 疾病构成显示,军事飞行人员肌肉骨骼系统疾病多年居首位,构成比是居第2位的消化系统疾病的2～3倍.与1995年比较,肌肉骨骼系统、感觉器官及泌尿生殖系统疾病的构成比上升显著;疾病谱显示腰椎间盘突出症、颈椎病、头痛、神经性耳聋和心律失常居前5位. 结论 21世纪前6年东北地区军事飞行人员常见病是腰椎间盘突出症、颈椎病、头痛、神经性耳聋和心律失常.提示转氨酶增高、半月板损伤和颈椎间盘突出症增加迅速,应引起关注.     

歼击机飞行员改装体检脊柱病症的医学鉴定

目的对近几年来我院改装体检歼击机飞行员脊柱病症健康鉴定进行归纳总结。方法收集分析了261例歼击机飞行员体检和X线、CT的影像诊断资料,并对因脊柱病症体检不合格资料进行统计学分析。结果歼击机飞行员体检中,脊柱影像诊断中以腰椎间盘突出(49例)最多,但多数没有相应的临床症状,有20例因脊柱病症不合格,其中腰椎双侧峡部裂伴Ⅰ°滑脱9例,占不合格总数的45%,是不合格的主要原因。结论外科体检中应该重点加强对脊柱的检查,影像诊断应结合症状和脊柱功能作出鉴定,必要时应作随访观察。     

导管射频消融治疗飞行员快速心律失常临床分析

目的探讨导管射频消融（RFCA）在治疗飞行员多种快速性心律失常中的安全性及临床应用价值，探讨飞行员快速性心律失常的航空医学鉴定标准。方法对13例快速性心律失常的飞行员进行了电生理（EP）检查，特发性室性心动过速（VT）1例，频发室性期前收缩（VE）2例，阵发性心房纤颤（AF）1例，房室折返性心动过速（AVRT）5例，房室结折返性心动过速（AVNRT）3例，房性心动过速（AT）1例。对其中12例采用RFCA治疗。结果RFCA即刻成功率为100％，全组无并发症发生。1例房性心动过速未行导管射频消融治疗。所有飞行员术后地面观察6个月后，返院进行随访复查，同时进行飞行鉴定。12例导管射频消融治疗，术后6个月24h动态心电图、12导联心电图检查和食道电生理检查均未检测到术前的同型快速性心律失常发作，延迟成功率为100％，医学鉴定合格。1例AT仍有发作，飞行不合格。结论对于飞行员快速性心律失常进行导管射频消融治疗是一种安全、有效的治疗方法。心脏电生理检查应作为飞行员快速性心律失常医学鉴定的主要指标之一。     

Factors Associated with Universal Free School Meal Provision Adoption among US Public Schools

BackgroundThe Community Eligibility Provision (CEP) allows high-poverty schools participating in US Department of Agriculture meal programs to offer universal free school meals. Emerging evidence suggests benefits of CEP for student meal participation, behavior, and academic performance. Although CEP became available nationwide in 2014, in school year 2019–2020, one third of eligible schools were not participating.ObjectiveThis study evaluates which school, district, and state factors are associated with CEP participation.DesignCross-sectional study comparing CEP-participating with eligible nonparticipating schools to assess the relationship between CEP participation and school, district, and state factors.ParticipantsUS public schools eligible for CEP in school year 2017–2018 (n = 42,813).Main Outcome MeasuresCEP participation.Statistical Analyses PerformedPenalized regression variable selection methods to determine which factors contribute information to the model. Generalized logistic regression to predict odds of CEP participation unadjusted and adjusted for each factor in the full sample and in stratified analyses by whether a state was part of the CEP phase-in period (early vs late implementing states).ResultsIn the full sample, adjusted odds of CEP participation were greater in states where CEP had been available longer (odds ratio [OR], 1.50; 95% confidence interval [CI], 1.34, 1.67). In late implementing states, adjusted odds of CEP participation were higher in schools with more students directly certified for free meals (OR in schools with 80%–89% vs 30%–39% directly certified: 19.32; 95% CI, 12.98, 28.76), Title I schools (OR, 1.85; 95% CI, 1.55, 2.21), and urban schools (OR suburban vs urban, 0.46; 95% CI, 0.36, 0.59). Differences by school level, enrollment, district size, student race/ethnicity, and geographic region also existed.ConclusionsFindings may help advocates, state agencies, and policymakers understand potential barriers to adoption and guide research exploring effective strategies to promote uptake. Future research should use qualitative and longitudinal designs to explore barriers to adoption, including cost and state and local policies.     

Automated clinical trial eligibility prescreening: increasing the efficiency of patient identification for clinical trials in the emergency department

Objectives (1) To develop an automated eligibility screening (ES) approach for clinical trials in an urban tertiary care pediatric emergency department (ED); (2) to assess the effectiveness of natural language processing (NLP), information extraction (IE), and machine learning (ML) techniques on real-world clinical data and trials.Data and methods We collected eligibility criteria for 13 randomly selected, disease-specific clinical trials actively enrolling patients between January 1, 2010 and August 31, 2012. In parallel, we retrospectively selected data fields including demographics, laboratory data, and clinical notes from the electronic health record (EHR) to represent profiles of all 202795 patients visiting the ED during the same period. Leveraging NLP, IE, and ML technologies, the automated ES algorithms identified patients whose profiles matched the trial criteria to reduce the pool of candidates for staff screening. The performance was validated on both a physician-generated gold standard of trial–patient matches and a reference standard of historical trial–patient enrollment decisions, where workload, mean average precision (MAP), and recall were assessed.Results Compared with the case without automation, the workload with automated ES was reduced by 92% on the gold standard set, with a MAP of 62.9%. The automated ES achieved a 450% increase in trial screening efficiency. The findings on the gold standard set were confirmed by large-scale evaluation on the reference set of trial–patient matches.Discussion and conclusion By exploiting the text of trial criteria and the content of EHRs, we demonstrated that NLP-, IE-, and ML-based automated ES could successfully identify patients for clinical trials.     

The Ontology of Clinical Research (OCRe): An informatics foundation for the science of clinical research

To date, the scientific process for generating, interpreting, and applying knowledge has received less informatics attention than operational processes for conducting clinical studies. The activities of these scientific processes – the science of clinical research – are centered on the study protocol, which is the abstract representation of the scientific design of a clinical study. The Ontology of Clinical Research (OCRe) is an OWL 2 model of the entities and relationships of study design protocols for the purpose of computationally supporting the design and analysis of human studies. OCRe’s modeling is independent of any specific study design or clinical domain. It includes a study design typology and a specialized module called ERGO Annotation for capturing the meaning of eligibility criteria. In this paper, we describe the key informatics use cases of each phase of a study’s scientific lifecycle, present OCRe and the principles behind its modeling, and describe applications of OCRe and associated technologies to a range of clinical research use cases. OCRe captures the central semantics that underlies the scientific processes of clinical research and can serve as an informatics foundation for supporting the entire range of knowledge activities that constitute the science of clinical research.     

飞行员阻塞性睡眠呼吸暂停低通气综合征的临床诊治及医学鉴定

目的回顾近年来飞行员阻塞性睡眠呼吸暂停低通气综合征（OSAHS）的临床诊疗情况及医学鉴定，以期提高航医对本病的认识。方法收集我院2003年3月至2006年3月收治的21例OSAHS飞行员，所有患者均经多导睡眠图（PSG）确诊，依据中华医学会呼吸病学分会睡眠呼吸疾病组制定的OSAHS诊治指南（草案）进行病情分度，按不同病情程度组收集临床资料及医学鉴定结果。结果21例OSAHS患者中，轻度患者8例，均无临床主诉及症状，未经治疗，医学鉴定结果为合格。中度患者3例，重度患者10例。13例中、重度患者中，4例因睡眠异常为主诉入院；3例经过短期无创通气（NIV）治疗，6例行腭咽腔成形术（UPPP）治疗；5例医学鉴定为合格，4例为暂不合格，4例为不合格。结论阻塞性睡眠呼吸暂停低通气综合征，尤其是中、重度患者可能损害飞行操作能力，出现飞行隐患。各级航卫部门应加强对本病的认识，以便早发现，早治疗，并提出医学鉴定原则。     

军事飞行学员医学停飞疾病谱分析

目的 总结分析空军某航空大学近年军事飞行学员医学停飞病征（疾病或体征）特点,为今后军事飞行学员医学选拔和医学鉴定提供客观依据. 方法 对近年空军航空大学医学停飞的614名飞行学员按照所患疾病或病征及病征所隶属体检科室（专业）进行分类统计. 结果 614名医学停飞学员共涉及病征90余种.飞行学员停飞病征排前10位的是视力不足超标、血压超标、频发心律失常、外伤（骨折）、腰椎间盘病变、鼻中隔偏曲、慢性鼻窦炎、胆囊息肉、晕厥及其他心电图异常.医学停飞病征所涉及体检科室（专业）排序依次为眼科、内科、外科、耳鼻喉科、神经内科、心电图检查、超声检查、放射科检查和检验科检查,其中以眼科和内科病征为主,分别占全部医学停飞病征的50.00％、14.86％. 结论 导致在校军事飞行学员医学停飞的主要病征是视力不足超标、血压超标.针对飞行人员职业特点,普及航空医学教育,加强卫生监督,加强可变的功能性病征的矫治、训练,采取积极保护性的干预和心理疏导等措施,对降低在校飞行学员的医学停飞率,提高军事飞行学员的成才率具有重要意义.     

Stratified analysis of multivariate clinical data: application of a Mantel-Haenszel approach

Laboratory determinations on children aged 6 to 10 years obtained over a 5-year period are analysed by a method described in detail for differentiating between children from exposed and control areas of Seveso, Italy. In the analysis, stratification is employed to distinguish the separate days of laboratory measurement. The analyses permit the study of differences based on all variables simultaneously as well as on each variable separately. Results are obtained for each individual year and for longer intervals of 2 successive years, 3 successive years, 4 successive years, and all 5 years. The results and some statistical aspects of the analysis are discussed.     

Imaging of Experimental Rat Gliomas Using a Clinical MR Scanner

Background: Studies of brain tumor development in experimental animal models have to date mostly been based on post-mortem histological examinations. The use of magnetic resonance imaging (MRI) may provide a non-invasive technique for studying tumor growth and treatment effects in such animal models. However, most of these studies have been performed on purpose-dedicated small bore magnetic resonance (MR) systems, of high cost and limited availability. The purpose of this study was thus to obtain high-resolution images of experimental gliomas in the rat brain, using a clinical 1.5T MR scanner. Methods: Anesthesized rats bearing BT₄C brain tumors were positioned into a specially designed immobilizing device, and a small circular coil was positioned onto the skulls. Two T1 weighted series were acquired before and after subcutaneous contrast injections. A T2 weighted series was also obtained. The rats were then sacrified, the brains removed, and the histological tumor volumes were compared to the volumes obtained on MRI. Results: There were visible tumors in 10 of 13 animals scanned on MR. The rim of the tumors were visualized on T1 weighted series without contrast. On T1 images with contrast, the tumors were seen as high signal intensity areas. The T2 weighted images showed peritumoral edema. No necrosis or cystic parts of the tumors were detected. There was a consistency between the MR and the histology findings, showing a high degree of correlation between the two volume determination methods. Conclusions: High-resolution images of experimental rat gliomas can be obtained using a clinical MR scanner and a commercially available RF coil. This MRI technique may also be expanded to extraneural rat tumor models, for studies of tumor development and treatment.