背景在推进单病种社区防治进程中,双向转诊是不可或缺的环节,但目前仍缺乏可指导一线实践的双向转诊实施方案。以骨质疏松为例,在整个诊疗路径中,骨科及相关科室专家的参与不可或缺,但全-专之间如何开展双向转诊仍有待探索。目的分析国...背景在推进单病种社区防治进程中,双向转诊是不可或缺的环节,但目前仍缺乏可指导一线实践的双向转诊实施方案。以骨质疏松为例,在整个诊疗路径中,骨科及相关科室专家的参与不可或缺,但全-专之间如何开展双向转诊仍有待探索。目的分析国内、外社区骨质疏松双向转诊实施现状,整理经验和不足,梳理有效做法和阻碍因素,为下一步落实社区骨质疏松双向转诊提供参考。方法于2019年6月,计算机检索中国知网、万方数据知识服务平台、Web of Science、Science Direct数据库中与社区开展骨质疏松双向转诊相关的文献,发表时间设定为1999-01-01至2019-06-15。分别从双向转诊的预期目标、双向转诊类型、双向转诊模式构建方法、双向转诊实施效果及当前面临的困境等方面,对国内、外社区骨质疏松双向转诊情况进行汇总分析,并提出优化建议。结果最终纳入中文文献14篇、英文文献5篇。国内、外骨质疏松双向转诊具有不同管理模式及转诊标准。在执行过程中,国内居民对骨质疏松重视度较低、治疗依从性较差,社区无正式专科、缺乏完善的检查设备及与二、三级医院间的信息沟通机制。国外的模式类型则局限于针对骨质疏松性骨折后患者的管理。结论要有效落实社区骨质疏松双向转诊,进而做好骨质疏松防控,应划定可长效防控骨质疏松的防治范围、加强社区全科医生骨质疏松诊疗知识储备、完善社区卫生机构防治环节所需物资配备、开发包含双向转诊分工细节与转诊指标的转诊流程四要素。展开更多
The carbon isotopic composition of organic matter （δ^13Corg） was determined in two sediment cores （IIL1 and IIL9） recovered from Inexpressible Island, Ross Sea, Antarctica, and analyzed to identify the sources of...The carbon isotopic composition of organic matter （δ^13Corg） was determined in two sediment cores （IIL1 and IIL9） recovered from Inexpressible Island, Ross Sea, Antarctica, and analyzed to identify the sources of that organic matter. The δ^13Corg values of sediments of IIL9 were found to vary between -14.6‰ and -11.6‰, with a mean of-13.4‰ （n=48）. These values were significantly higher than those of IIL1 sediments which varied between -23.2‰ and -20.4‰, with a mean of-21.8%o （n=55）. The variation in δ^13Corg values in these two sediment cores indicate different sources of organic matter, The relatively high 6~3Corg values in IIL9 are in accordance with a source from algae, while the low δ^13Corg values in IIL1 evince significant influence from penguin guano with algae as the secondary source. Compared with the reference data from other high-latitude lake sediments and plants, the δ^13Corg values in IIL9 were extremely high, a result likely related to intense competition for CO2 assimilation among algal species during the growing season in this relatively shallow pond. These results indicate that sedimentary δ^13Corg is a reliable proxy for paleo-primary productivity in ponds at Inexpressible Island.展开更多
文摘背景在推进单病种社区防治进程中,双向转诊是不可或缺的环节,但目前仍缺乏可指导一线实践的双向转诊实施方案。以骨质疏松为例,在整个诊疗路径中,骨科及相关科室专家的参与不可或缺,但全-专之间如何开展双向转诊仍有待探索。目的分析国内、外社区骨质疏松双向转诊实施现状,整理经验和不足,梳理有效做法和阻碍因素,为下一步落实社区骨质疏松双向转诊提供参考。方法于2019年6月,计算机检索中国知网、万方数据知识服务平台、Web of Science、Science Direct数据库中与社区开展骨质疏松双向转诊相关的文献,发表时间设定为1999-01-01至2019-06-15。分别从双向转诊的预期目标、双向转诊类型、双向转诊模式构建方法、双向转诊实施效果及当前面临的困境等方面,对国内、外社区骨质疏松双向转诊情况进行汇总分析,并提出优化建议。结果最终纳入中文文献14篇、英文文献5篇。国内、外骨质疏松双向转诊具有不同管理模式及转诊标准。在执行过程中,国内居民对骨质疏松重视度较低、治疗依从性较差,社区无正式专科、缺乏完善的检查设备及与二、三级医院间的信息沟通机制。国外的模式类型则局限于针对骨质疏松性骨折后患者的管理。结论要有效落实社区骨质疏松双向转诊,进而做好骨质疏松防控,应划定可长效防控骨质疏松的防治范围、加强社区全科医生骨质疏松诊疗知识储备、完善社区卫生机构防治环节所需物资配备、开发包含双向转诊分工细节与转诊指标的转诊流程四要素。
基金the Chinese Arctic and Antarctic Administration of the State Oceanic Administration for project supportthe United States Antarctic Program (USAP)+2 种基金Antarctic Support Contract and Italian Mario Zucchelli Station for logistical support. R. Murray and A. Mc Kenzie provided valuable assistance in the fieldsupported by the National Natural Science Foundation of China (Grant nos. 41576183 and 41376124)National Science Foundation (Grant no. ANT 0739575)
文摘The carbon isotopic composition of organic matter （δ^13Corg） was determined in two sediment cores （IIL1 and IIL9） recovered from Inexpressible Island, Ross Sea, Antarctica, and analyzed to identify the sources of that organic matter. The δ^13Corg values of sediments of IIL9 were found to vary between -14.6‰ and -11.6‰, with a mean of-13.4‰ （n=48）. These values were significantly higher than those of IIL1 sediments which varied between -23.2‰ and -20.4‰, with a mean of-21.8%o （n=55）. The variation in δ^13Corg values in these two sediment cores indicate different sources of organic matter, The relatively high 6~3Corg values in IIL9 are in accordance with a source from algae, while the low δ^13Corg values in IIL1 evince significant influence from penguin guano with algae as the secondary source. Compared with the reference data from other high-latitude lake sediments and plants, the δ^13Corg values in IIL9 were extremely high, a result likely related to intense competition for CO2 assimilation among algal species during the growing season in this relatively shallow pond. These results indicate that sedimentary δ^13Corg is a reliable proxy for paleo-primary productivity in ponds at Inexpressible Island.
