四川省三州地区卫生人力资源配置与公平性评价分析

目的:了解2011-2017年四川省三州地区卫生人力资源配置现状,为三州地区卫生人力资源的合理配置提供参考。方法:利用千人卫生人力资源拥有量指标、基尼系数和卫生人力资源密度指数(HRDI)分析卫生人力资源配置现状及其公平性。结果:三州地区千人卫生人力资源拥有量呈增长趋势;基尼系数大多超过0.4,仅护士按人口分布的基尼系数较小;卫生人力资源密度指数较小,需要量、缺乏量及缺乏比例均较大。结论:三州地区卫生人力得到一定程度改善;但配置公平性较差,尤其按地理、经济分布很不均衡;医护人员短缺,需要重点投入。     

Troubled-Cell Indicator Based on Mean Value Property for Hybrid WENO Schemes

In this paper, we introduce a new type of troubled-cell indicator to improve hybrid weighted essentially non-oscillatory (WENO) schemes for solving the hyperbolic conservation laws. The hybrid WENO schemes selectively adopt the high-order linear upwind scheme or the WENO scheme to avoid the local characteristic decompositions and calculations of the nonlinear weights in smooth regions. Therefore, they can reduce computational cost while maintaining non-oscillatory properties in non-smooth regions. Reliable troubled-cell indicators are essential for efficient hybrid WENO methods. Most of troubled-cell indicators require proper parameters to detect discontinuities precisely, but it is very difficult to determine the parameters automatically. We develop a new troubled-cell indicator derived from the mean value theorem that does not require any variable parameters. Additionally, we investigate the characteristics of indicator variable; one of the conserved properties or the entropy is considered as indicator variable. Detailed numerical tests for 1D and 2D Euler equations are conducted to demonstrate the performance of the proposed indicator. The results with the proposed troubled-cell indicator are in good agreement with pure WENO schemes. Also the new indicator has advantages in the computational cost compared with the other indicators.     

基于超效率DEA的天津市基本公共卫生配置资源效率研究

评价天津市各辖区基本公共卫生服务的资源配置效率,寻求有效的资源配置措施和方法,为进一步优化卫生资源配置提供参考依据。方法利用数据包络分析,对天津市16辖区的基本公共卫生服务进行效率评价。结果天津市基本公共卫生服务的资源配置效率整体不高,仅有5辖区达到了规模最优,多数区非DEA有效,且投入过剩与产出不足并存。结论为了达到最优的基本公共卫生服务效率,政府及各级基本公共卫生服务机构必须有效地完善、落实相关政策,优化资源投入结构,统筹地区差异,加强资源供给管理,提高资源利用效率。     

Inactivated influenza vaccine formulated with single-stranded RNA-based adjuvant confers mucosal immunity and cross-protection against influenza virus infection

Influenza vaccination is considered the most valuable means to prevent and control seasonal influenza infections, which causes various clinical symptoms, ranging from mild cough and fever to even death. Among various influenza vaccine types, the inactivated subunit type is known to provide improved safety with reduced reactogenicity. However, there are some drawbacks associated with inactivated subunit type vaccines, with the main ones being its low immunogenicity and the induction of Th2-biased immune responses. In this study, we investigated the role of a single-stranded RNA (ssRNA) derived from the intergenic region in the internal ribosome entry site of the Cricket paralysis virus as an adjuvant rather than the universal vaccine for a seasonal inactivated subunit influenza vaccine. The ssRNA adjuvant stimulated not only well-balanced cellular (indicated by IgG2a, IFN-γ, IL-2, and TNF-α) and humoral (indicated by IgG1 and IL-4) immune responses but also a mucosal immune response (indicated by IgA), a key protector against respiratory virus infections. It also increases the HI titer, the surrogate marker of influenza vaccine efficacy. Furthermore, ssRNA adjuvant confers cross-protective immune responses against heterologous influenza virus infection while promoting enhanced viral clearance. Moreover, ssRNA adjuvant increases the number of memory CD4⁺ and CD8⁺ T cells, which can be expected to induce long-term immune responses. Therefore, this ssRNA-adjuvanted seasonal inactivated subunit influenza vaccine might be the best influenza vaccine generating robust humoral and cellular immune responses and conferring cross-protective and long-term immunity.     

中国鼠疫菌种资源遗传特征分析

目的 建立《中国甲类传染病菌种资源库》，选择适当的指标，以反映中国鼠疫菌种的遗传背景。方法 使用传统的和分子生物学方法，测定中国鼠疫菌种代表菌株的遗传特征。并对遗传特征的分布及其意义进行分析。结果 利用6项指标，将中国的鼠疫菌划分成15种遗传型，每一型占据一片相对独立的而又自相延续的地理空间。分析遗传型之间的亲缘关系，并根据菌株间的差异，追溯鼠疫耶尔森菌作为一个生物种形成后的进化过程。结论 中国各鼠疫自然疫源地存在着不同特征的鼠疫菌株，但为达到对菌株认同的目标，还需要确定更多的遗传指征。     

高原地区部队医院谋求新发展应处理好七个关系

从高原部队医院实际出发,阐述了适应新形势谋求新发展应处理好的七个关系:即继承与创新的关系;坚持“姓军为兵的服务方向与对外有偿服务的关系;基础建设与人才建设的关系;日常医疗保障与科研的关系;发挥自身特色与学习借鉴的关系;硬件建设与软件建设的关系;科技研究与成果转化的关系。     

防止银器文物变色的唑系复合缓蚀剂Ⅰ. 缓蚀剂成膜处理工艺与防变色性能的评定

:通过按正交法设计的紫外光照曝露等加速大气腐蚀实验 ,研究了用于防止银变色的唑系复合缓蚀剂成膜处理的工艺 ,并评定其对模拟文物银试片的防变色性能。采用极化曲线和交流阻抗Nyquist图 ,讨论了防变色作用的电化学机理。实验结果表明 ,缓蚀剂 PMTA、MBI和 MBO具有较好的协同作用 ,银试片在 5 0°C、p H 3.0、组分 MBO∶ PMTA∶ MBI为 1∶ 1 .7∶ 3(摩尔比 )、复合缓蚀剂浓度为 0 .0 1 89mol/L的溶液中 4h成膜处理后 ,经 48h硫华气氛和 36h紫外光曝露腐蚀实验 ,无色斑出现 ,表明缓蚀膜明显地提高了银试片的抗变色能力     

区域性卫生规划及卫生资源配置标准的比较分析

目的：比较分析各地区域性卫生规划和卫生资源配置标准，为制定下阶段的区域卫生规划和资源配置标准提供科学依据。方法：采用文献定性和定量的分析方法，比较不同地区区域性卫生规划文献发表的数量、文献的主题和卫生资源配置标准等。结果：东部地区所发表的论文数量多于西部地区，但各地区发表文献的主题无显著差异；每千人口床位数、每千人口执业医师数、每千人口的执业护士数、每百万人口的CT和MRI数东部地区均高于西部地区；四川省各项指标低于西部地区。结论：区域性卫生规划和卫生资源的配置是改善和提高区域内的卫生综合服务能力以及卫生资源利用效率的重要措施，各地区的资源配置应与社会经济的发展相一致，要充分体现公平和效率、合理和实用的原则。     

Organization of intensive care units in Europe: lessons from the EPIC study

Objective: To study differences related to intensive care unit (ICU) structure and patient demography between the various countries of Western Europe. Design: Application of data collected by the European Prevalence of Infection in Intensive Care (EPIC) study, a one-day prevalence study. Setting: Voluntary participation of all Western European ICUs. A total of 1417 ICUs responded. Patients: All patients, older than 10 years of age, occupying a bed in the participating ICUs over a 24-h period. 10 038 patient case reports were submitted. Results: The study revealed important differences. In particular, there seems to be a north/south divide with fewer ICU beds and more severely ill patients in the south. The United Kingdom seemed more similar to southern European countries than to the north. Conclusion: While there are similarities between European countries, large differences still remain and are important to identify to enable us to work together to create a more uniform system of intensive care, which will in turn give more effective and efficient patient care. Received: 7 February 1997 Accepted 8 July 1997     

Hospital care of osteoporosis-related vertebral fractures

 Resource implications of hospitalization for osteoporosis-related vertebral fracture are sparsely documented. This study utilized data abstracted from a national sample of hospitalized patients to identify characteristics of patients who are hospitalized with vertebral fracture and their patterns of resource utilization. These were compared with patterns observed for hip fracture hospitalizations. Data from the Nationwide Inpatient Sample (NIS) for 1997 were used to identify men and women age 45 years and above who had a primary diagnosis of vertebral fracture. After patients whose fractures might have been due to metastatic cancer or severe trauma were excluded, 68 901 individuals hospitalized for vertebral fracture were identified. Seventy-seven percent of these were women, most were white, 75 years and older, and had multiple comorbid diagnoses. Total charges averaged US$8000–10 000 per hospitalization and were higher in men. Mean length of stay was just under 6 days and more than 50% of discharged patients required some form of continuing care. Hospitalizations for vertebral fracture occurred at only one-fourth the rate of those for hip fracture, and created only half the hospital charges per admission. Vertebral fracture accounted for over 400 000 total hospital days and generated charges in excess of US$500 million. This resource impact is considerably higher than has been described in prior studies. Received: 25 June 2002 / Accepted: 13 August 2002 Acknowledgement This research was supported by Procter & Gamble Pharmaceuticals and Aventis.