Classification and cyclic fatigue evaluation of new kinematics for endodontic instruments

This study evaluated the effect of new motions of the motor TriAuto ZX2 on the cyclic fatigue of endodontic instruments. Vortex Blue 35.06 instruments were divided into four groups (n = 10) and tested for fatigue in a curved artificial canal (90° and 2 mm radius) using the following motions: continuous rotation (CR), Optimum Torque Reverse (OTR) set at 180° and the Optimum Glide Path (OGP), which was tested at 90° and 240°. The time to fracture (TTF) and the lengths of the fractured fragments were recorded. The mean TTF was significantly different among the groups (anova , P < 0.05): OGP 90° (213.39 ± 27.45), OTR 180° (121.24 ± 17.03), OGP 240° (45.24 ± 5.61) and CR (8.43 ± 1.27). Weibull analysis confirmed the shortest life expectancy for CR and the longest survival for OGP at 90°. The resistance to fatigue was affected by motions and pre‐set angles. The proprietary movements that are currently available for endodontic instruments were classified according to their kinematics.     

人格特征、自尊水平与航空兵部队人员心理健康的关系

目的:探讨航空兵部队人员人格特征、自尊水平与心理健康的关系。方法:运用EPQ、SES、SCL-90对443名航空兵部队人员进行调查。结果:神经质与SCL-90总均分成正相关(r=0.641,P<0.01);内外向与SCL-90总均分成负相关(r=-0.232,P<0.01);精神质与SCL-90总均分成正相关(r=0.398,P<0.01);自尊水平与SCL-90总均分成负相关(r=-0.381,P<0.01);神经质、精神质、自尊水平进入回归方程(P<0.001);神经质、精神质对心理健康有直接影响(效应系数分别为0.513和0.209);内外向、神经质通过影响自尊水平对心理健康具有间接效应(效应系数分别为0.216和-0.261)。结论:神经质、精神质和内外向是影响心理健康的因素,具有直接作用和间接作用两个方面;自尊是人格影响心理健康的中间环节。     

深化校企合作培养高素质药学人才的思考

校企合作是贯彻落实科教兴国和人才强国战略的重要举措。药学的实践性与应用性决定了药学教育必须走理论联系实际、教育教学与生产实践相结合的育人道路。药学院校需要进一步提高对校企合作重要性及必要性的认识,深化拓展校企合作,培养高素质药学人才。     

书院制模式下高校医学生医德教育新路径探析——以西安交通大学书院制为例

从我国古代书院制及国外书院制教育环境及特点分析入手,结合西安交通大学书院制学生管理模式,从书院推行通识教育,实施学生综合能力提升计划,打造本科生教育"第二课堂",营造和谐学生生活社区及书院特色文化等方面,为医学生医德教育探索出一条新的路径。     

Exploring factors associated with asthma-related emergency department visits among adults: A path analysis approach

Background

Asthma is an expensive chronic lung disease that affects 7% of U.S. adults and results in as many as 1.8 million emergency department (ED) visits each year. Pharmacists play an important role in managing asthma, including assessing control and monitoring disease progression, educating the patient about the disease and associated treatments, and ensuring safe and cost-effective medication use. However, comprehensive studies that account for the complex relationships between factors impacting asthma-related ED visits are lacking in the adult asthma population.

制度变迁视角下完善医师多点执业的思考

作为促进医师流动、优化卫生资源配置的重要举措,多点执业被寄予厚望,但实践中多点执业却遭受冷遇。从制度变迁视角来看,遇冷的根本原因在于既有制度和思维中存在的路径依赖：首先,政府管制体制具有强大的制度惯性将医师锁定在医院中,医师多点执业的合法性与合理性并不统一。其次,医院之间竞争的白热化,多点执业对于医院和医师责权利分配格局统一性的挑战使医院对多点执业冷淡。再次,思维观念中的求稳倾向与追求利益的欲求,使医师对多点执业采取观望态度。因此,多点执业的制度变迁需要加快政府制度创新,为多点执业解锁,实现合法性与合理性的统一;转变医院运行逻辑,扼制逐利动机,推行多点执业契约管理;转变医师思维模式,正视医师利益需求,构建多点执业激励机制。     

系统变异管理对临床路径的影响

目的 研究临床路径实施过程中出现的系统变异及变异原因,探索干预措施,旨在降低可控变异的发生率.方法 选择妇科、神经内科两个试点科室共11个病种为受试对象,将2011年1月～6月进入临床路径的受试对象1682例设为对照组,将2012年7月～12月进入临床路径的受试对象5 639例设为研究组,比较两组的变异差异情况.结果 对照组病例数1 683例,变异例数489,变异率29.1％;研究组病例数5 639,变异数962,变异率17.06％.两组比较,因主管医生检查滞后、检查结果滞后、费用滞后、不配合检查、自动出院,路径设计缺陷原因引起的变异有显著差异,P＜0.05;因设备故障,共病情况原因引起的变异无显著差异,P＞0.05.主管医生检查滞后、检查结果滞后和路径设计缺陷能够单独引起系统变异,P＜0.05.而设备故障不能单独引起系统变异,P＞0.05.结论 通过全面优化医疗服务流程,完善信息化建设、加强医院硬软件建设等措施,能够明显降低由于系统管理缺陷导致的临床路径系统变异,明显减少临床路径负变异,增加正变异.     

艺术类大学新生人性哲学观的影响因素路径分析

目的研究艺术大学新生人性哲学特征及其影响因素。方法采用人性的哲学量表、人性的哲学修订量表、青少年生活事件量表、症状自评量表及卡特尔16种人格特质问卷对1019名艺术学生进行测试。结果不同性别、家庭状态下人性观存在差异:男生在利他主义正性、意志力与理性正性上得分明显低于女生(P0.05);单亲家庭的新生在值得信任正性上得分低于非单亲家庭(P=0.016)。个性、心理、生活事件各因素均与人性观存在一定相关性:16PF中12个因子与人性观中各因子具有不同程度相关性(r=-0.204~0.290,P0.05);SCL-90各因素与值得信任负性、利他主义负性、意志力与理性负性、人性复杂性正性这4个因子无相关性,与剩余分量表大多存在显著相关(r=-0.315~0.062,P0.05);艺术新生除值得信任负性、利他主义负性、人性复杂性正性、愤世嫉俗外的其他因子均与生活事件的各方面存在显著相关(r=-0.068~-0.243,P0.05);路径分析结果显示,乐群性对新生个性贡献最大(β=0.72),个性、生活事件对正负人性观的直接影响均显著(β1=0.14,0.12,β2=-0.21,-0.14),个性在生活事件及人性观之间的间接效应显著(β=0.03)。结论大学新生处于人性观形成和发展的关键时期,从提高心理健康程度、培养良好个性特征、关注负性生活事件的发生三方面入手,促进正性人性观的形成和发展。     

老年缺血性脑卒中患者社会网络与认知功能的相关性研究

目的探讨老年脑卒中患者社会网络与认知功能及其各领域的相关性。方法采用简易精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、记忆与执行筛查量表(分为MES-M和MES-E)、语言功能量表(LAST)、社会网络量表(LSWS-6)对2018年8月-2019年5月复旦大学附属上海市第五人民医院收治的141例老年脑卒中患者进行评估;采用Pearson和Spearman相关对认知功能的影响因素进行单因素分析,基于社会网络影响健康结局的理论和单因素分析结果建立结构方程模型。结果研究对象中认知障碍与轻度认知障碍发生率分别为33.3%和94.3%。路径分析显示:年龄、婚姻状况、文化程度、有氧运动、抑郁状态、神经功能缺损评分(NIHSS)等直接和(或)间接影响老年患者认知功能,社会网络在文化程度与MMSE、MoCA、MES-M之间起中介作用,中介效应值分别为0.047、0.065、0.092,社会网络在抑郁状态与MMSE之间的中介效应值为-0.105。结论脑卒中后认知障碍在老年缺血性脑卒中患者中十分常见,受多种因素影响,抑郁状态和社会网络均对认知功能有显著影响,社会网络在抑郁状态与认知功能之间起中介作用。医护人员及其照顾者应注意加强老年患者社会交往活动,以延缓脑卒中后认知障碍进展过程。     

The Impact of Emotional Exhaustion on Psychological Factors in Workers with Secondary Traumatic Experiences: A Multi-Group Path Analysis

Objective The objective of the present study was to explore causal pathways to understand how second traumatic experiences could affect the development of emotional exhaustion and psychiatric problems. Methods A total of 582 workers who had jobs vulnerable to secondary traumatic experiences were enrolled for this study. Emotional exhaustion, secondary trauma, resilience, perceived stress, depression, anxiety, and sleep problems were evaluated. A model with pathways from secondary traumatic experience score to depression and anxiety was proposed. The participants were divided into three groups according to the resilience: the low, middle and high resilience group. Results Resilience was a meaningful moderator between secondary traumatic experiences and psychiatric problems. In the path model, the secondary trauma and perceived stress directly and indirectly predicted perceived stress, emotional exhaustion, depression, anxiety, and sleep problems in all three groups. Direct effects of perceived stress on depression and anxiety were the largest in the low resilience group. However, direct effects of secondary trauma on perceived stress and emotional exhaustion were the largest in the high resilience group. Conclusion Understanding the needs of focusing for distinct psychological factors offers a valuable direction for the development of intervention programs to prevent emotional exhaustion among workers with secondary traumatic experiences.