How current risk assessment and risk management methods for drinking water in The Netherlands cover the WHO water safety plan approach

In the Netherlands, safe and sufficient drinking water is provided to the general population by ten drinking water companies. To guarantee safe drinking water the World Health Organization (WHO) developed a Water Safety Plan (WSP), a Risk Assessment and a Risk Management (RA/RM) framework. The objective of the study was to identify legally required RA approaches, to document application of RA/RM activities at Dutch drinking water companies and to determine to what extent these RA/RM activities as a whole cover all the elements of the WHO WSP approach. This study could be of interest to both managers of large water utilities and decision makers.The assessment was performed by means of a policy review and interviews with two to four staff members involved in RA/RM from all ten Dutch drinking water companies combined with a joint workshop. The drinking water companies are well aware of the potential hazards and risks that can influence the drinking water quality. To guarantee the supply of safe and sufficient drinking water, the Dutch drinking water sector uses six different legally required RA/RM approaches. This study shows that by using the six legally required RA/RM approaches, all WSP steps are covered. WSP entails a generic risk assessment for identifying all hazards and hazardous events from source to tap, whereas the six legally required RA/RM each focus on specific risks at an advanced level. Each risk assessment provides information on specific hazards and hazardous events covering a part of the water supply chain. These legal requirements are complemented with additional RA/RM activities at sector and water company level such as codes of practices and standard operating procedures. The outcomes of all RA/RM approaches combined provide information from source to tap. When using multiple RA/RM approaches, it is crucial to share and combine information derived from the different activities.     

食管癌放疗中二次模拟定位临床探讨

目的：探讨食管癌放疗中间再次定位的必要性和重要性。方法：我院放疗科自1998年10月－2001年3月对356例食管癌患者行单纯放疗或放疗加化疗，356例患者照射全过程都进行二次模拟定位（第一次模拟定位后照射30－40GY／15－20次后进行第2次模拟定位）。比较分析前后二次模拟定位靶中心移位的情况。结果；靶中心移位＜0．5cm为157例，移位0．5－1．0cm为130例，移位＞1．0cm为69例。全部靶中心移位达55．90％。食管肿瘤长度＜5cm靶中心移位27例，5－8cm移位117例，病变长度＞8cm移位55例，P＜0．05；食管肿瘤发生于颈段，上胸段靶中心移位25例，而中、下段食管移位174例，P＜0．01。结论：食管肿瘤外照射达到一定剂量时，靶中心会出现不同程度的移位，肿瘤长度越长靶中心移位会更明显， 肿瘤位置越小，移位亦显著。因此，我们对食管癌患者放疗全过程必需进行2到3次定位，这样才能保证靶中心的精确度，以达到预期治疗目的。     

非霍奇金淋巴瘤采用CHOP方案治疗与护理

目的探讨NHL采用CHOP方案治疗中护理的重要性.方法对115例NHL采用CTX,750mg/m2 静滴第1日,VCR 1.4g/m2静滴第1.8日,PDN100mg/m2PO第1～5日,每21天为1周期,本组病例用药4～6个周期.结果顺利地完成了115例NHL的化疗,无1例出现化疗作用.结论肿瘤专科护理的措施是顺利完成化疗,减轻副作用,提高生活质量的保证.     

How Frequent Are Asthma Exacerbations in a Pediatric Primary Care Setting and Do Written Asthma Action Plans Help in Their Management?

Purpose. In the National Heart, Lung, and Blood Institute Guidelines for the Diagnosis and Management of Asthma, the expert panel recommends that a written asthma action plan be provided for all patients with asthma. Studies evaluating the usefulness of the asthma action plan in children are limited. We aim to determine exacerbation frequency and usefulness of the asthma action plan in managing exacerbations that occur in a pediatric primary care setting. Methods. Caretakers of asthmatic children attending the general pediatric clinic in an inner-city hospital completed a one-page questionnaire covering topics such as asthma severity, frequency of exacerbations, and possession/usefulness of an asthma action plan. Although controversy exists over the definition of yellow and red zone exacerbations, we defined the yellow zone as symptoms that require albuterol more than three times a day or more than two nights in succession. The red zone was defined as symptoms requiring systemic corticosteroids and/or an urgent physician visit. Results. Seventy of 75 subjects completed the survey. Almost 80% of respondents carried the diagnosis of persistent asthma, whereas the remainder had intermittent asthma. Exacerbation frequency over a 3-month period was determined. Approximately 80% of children experienced at least one yellow zone episode: 42% had one or two yellow zone episodes, and 39.6% had between three and five episodes. Sixty-three percent of patients did not experience a single red zone exacerbation. Almost 75% (44 of 59) of subjects possessed an asthma action plan. Ninety percent (37 of 41) of respondents with action plans found the plan to be useful in managing exacerbations. Conclusion. Approximately four of every five asthmatic children seen in this primary care setting experienced a yellow zone exacerbation at least once during a 3-month period. One third experienced at least one red zone episode. Nine of every 10 caretakers with an action plan reported the asthma action plan to be of value in managing exacerbations.     

The Effect of Health Plan Characteristics on Medicare+Choice Enrollment

Objective. To provide national estimates of the effect of out-of-pocket premiums and benefits on Medicare beneficiaries' choice among managed care health plans.
Data Sources/Study Setting. The data represent the population of all Medicare+Choice (M+C) plans offered to Medicare beneficiaries in the United States in 1999.
Study Design. The dependent variable is the log of the ratio of the market share of the j th health plan to the lowest cost plan in the beneficiary's county of residence. The explanatory variables are measures of premiums and benefits in the j th health plan relative to the premiums and benefits in the lowest cost plan.
Data Collection Methods. The data are from the 1999 Medicare Compare database, and M+C enrollment data from the Centers for Medicare and Medicaid Services (CMS).
Principal Findings. A $10 increase in an M+C plan's out-of-pocket premium, relative to its competitors, is associated with a decrease of four percentage points in the j th plan's market share (i.e., from 25 to 21 percent), holding the premiums of competing plans constant.
Conclusions. Although our price elasticity estimates are low, the market share losses associated with small changes in a health plan's premium, relative to its competitors, may be sufficient to discipline premiums in a competitive market. Bidding behavior by plans in the Medicare Competitive Pricing Demonstration supports this conclusion.     

Provider networks and health plan premium variation

ObjectiveTo examine how plan premiums are associated with physician network breadth, hospital network breadth, and hospital network quality on the Affordable Care Act''s Health Insurance Marketplaces in all 50 states and the DC in 2016.Data SourcesData on plan premiums and characteristics came from 2016 Robert Wood Johnson Foundation Health Insurance Exchange (HIX) Compare. Provider network information was obtained from Vericred. Hospital characteristics were obtained from CMS Hospital Compare and the American Hospital Association (AHA) survey.Study DesignWe analyzed how plan premiums were associated with variations in physician network breadth, hospital network breadth, and hospital network quality using ordinary least square regressions with state‐rating area fixed effects and carrier fixed effects.Principal FindingsPlan premiums were positively associated with physician network breadth and hospital network breadth. We find the following statistically significant results: a one standard deviation increase in physician network breadth was linked to a premium increase of 2.8 percent or $101 per year; a one standard deviation increase in hospital network breadth was linked to a premium increase of 2.4 percent or $86 per year. There was no significant association between premiums and hospital network quality, as measured by hospital star ratings and the inclusion of teaching hospitals or the top‐20 hospitals nationwide.ConclusionsPhysician network breadth and hospital network breadth contributed positively to plan premiums. The roles of the two types of provider network breadth are quantitatively similar. Premiums appear to be insensitive to hospital network quality.     

上海市中心城轨道交通网络规划合理规模研究

介绍了估算城市轨道交通网络规划规模的3种方法--几何分析法、运输强度分析法及类比分析法,并结合上海市的实际情况对上海市中心城轨道交通网络规划规模进行了估算。通过对比和分析各种估算结果,提出了上海市中心城轨道交通网络规划的合理规模。     

解放军302医院药学部防治SARS应急预案

为进一步做好SARS的预防和控制，切实有效地保障解放军302医院药品供应工作，我院制定了SARS的应急预案，并付诸实施，旨在提高药学部对于突发公共卫生事件的快速反应能力和应急处理能力。     

人体生理学电子教案的制作与应用

与统编教材配套的系列人体生理学电子教案紧贴教学大纲 ,以PowerPoint为媒体 ,制作编辑了数百幅动画和精美的图片 ,形象直观 ,使学生能很好地掌握课本中的重点和难点问题。该教案使用方便 ,且能在网络上运行 ,在实践中取得了良好的教学效果。     

"入世"后中医药科技面临的机遇、挑战与对策

对“入世”后中医药科技面临的机遇和挑战进行分析。认识应研究开发符合市场需求的现代中药,建立我国中药现代研究开发体系,形成我国科技先导型中药产业,培育中药跨国产业集团,培育外向型、复合型高级中药人才;并对中成药进入国际市场、另药新药研制提出了具体设想。