The Alvalade's neighborhood (Lisbon, Portugal), 1945, as a paradigm of Portuguese urbanism, can be distinguished by different housing cells that define it, as well as the different urban models, which relied on. It...The Alvalade's neighborhood (Lisbon, Portugal), 1945, as a paradigm of Portuguese urbanism, can be distinguished by different housing cells that define it, as well as the different urban models, which relied on. It is possible to identify distinct occupational stains within the neighborhood, specifically in the cell one in this article, as a pioneer construction, due to housing dimension that corresponds to different housing typologies, residents and daily use areas, equipment. The objective is therefore, to understand how these three factors are reflected inside the cell, managing occupational stains which differ in space appropriation. How those different occupational stains that derive from the housing and urban morphology, may result in the occupation and experience of its inhabitants, not invalidating a cohesive structure of the neighborhood?展开更多
Background: Workers spend a significant amount of time in the workspace. Involvement of a spouse in a doctor’s workplace can take different forms and come with different intentions. Objectives: The survey aimed to de...Background: Workers spend a significant amount of time in the workspace. Involvement of a spouse in a doctor’s workplace can take different forms and come with different intentions. Objectives: The survey aimed to determine the prevalence and extent of spousal involvement in physicians’ workplaces as well as the outcome of such involvement on doctor’ swell-being, productivity, and relationship with colleagues. Methods: This cross-sectional online survey on spousal involvement in the workplace of doctors was conducted among 83 responding doctors from July to August 2023. Results: Among the respondents, 60 (72.3%) had witnessed a doctor’s spouse being involved in the workplace. The most common reason for spousal involvement in the workplace was to protect the spouse from what they perceived as a threat 34 (54.0%). Spouse’s ignorance of boundaries in the workplace (OR: 6.09 (95% CI: 1.70, 21.79) P: 0.003) and exertion of control by the spouse (OR: 11.2 (95% CI: 2.26, 56.41) P: 0.002) were significantly associated with higher odds of inappropriate spousal involvement in the workplace, while expression of love for spouse with acts of kindness was significantly associated with a lowered odd of inappropriate spousal involvement (OR: 0.11 (95% CI: 0.03, 0.36) P: 0.0001). Conclusion: Spousal involvement in the workplace is relatively common. Ignorance of the boundaries of the workplace and exertion of control by the spouse were significant enablers of inappropriate spousal involvement in the workplace of doctors. The establishment of workplace policies that define the limits of spousal involvement in the doctor’s workplace can foster a healthy workspace environment, enhance doctors’ well-being, and improve patient care.展开更多
Background: Use of inappropriate amikacin dose is one of the most important factors in inducing toxicity, prolonged hospitalization as well as in increasing patient’s mortality. Objective: The aims of this study are ...Background: Use of inappropriate amikacin dose is one of the most important factors in inducing toxicity, prolonged hospitalization as well as in increasing patient’s mortality. Objective: The aims of this study are the analysis of amikacin dose, serum level and the examination of the effectiveness of the clinical pharmacologist (CP) therapeutic drug monitoring (TDM) intervention to guarantee the safety of amikacin use. Methods: This is a one-year retrospective observational chart review study, which evaluates amikacin dose, serum drug level, development of adverse effects in patients on amikacin with or without CP TDM consultation. Results: Amikacin was prescribed for 393 complex patients, with median age 83. Amikacin group (AG) included 140 (32%) courses with CP consultation (AG1) and 292 (68%) courses without CP consultation (AG2). The distribution of most study characteristics in both groups was similar including amikacin dose (9-10 mg/kg/day), renal failure (14%) and mortality (12%). Acceptance for CP consultation was in 46% of amikacin courses and dose changes were done in 63% after CP intervention. Prolonged antibiotic course (4.6 ± 1.5 vs 3.8 ± 1.6 days, p < 0.0001) and the patient’s hemodynamic instability (15% vs 7%, p = 0.01) were more frequent in the AG1 compared to the AG2. There was a strong association between CP consultation and prolonged hospitalization (p = 0.005), while no association between it and amikacin adverse effects, renal failure or mortality. Conclusions: There was no trend to reducing amikacin toxicity, days of hospitaliza tion or mortality in patients with CP consultation. CP TDM intervention was more in the management of complicated clinical situations. However, it is necessary to optimize it.展开更多
The accelerating urbanization process leads to aggravated environmental problems, thus garden design which is a creative activity connecting human and nature has attracted much attention, and also garden designers hav...The accelerating urbanization process leads to aggravated environmental problems, thus garden design which is a creative activity connecting human and nature has attracted much attention, and also garden designers have had to rethink about environmental ethics and morals. This study, from the perspective of environmental ethics, duly proposed the brand-new concept of 'appropriate garden of primitive ecology', proceeded from the orientation, form, value, theoretical basis, realistic significance, culture and consumption psychology of 'garden of primitive ecology', fully developed outstanding ecological wisdoms and morals in traditional Chinese garden culture, boosted garden designs to the environmental ethics level of eco-justice, to seek for the approach to 'garden of primitive ecology' with indigenous Chinese environmental ethic characteristics.展开更多
Based on the constructivism, using the College English(new edition) CD-ROMs for classroom teaching as main media, this paper explores the feasibility of the classroom teaching mode of appropriate combination of trad...Based on the constructivism, using the College English(new edition) CD-ROMs for classroom teaching as main media, this paper explores the feasibility of the classroom teaching mode of appropriate combination of traditional methods with the multimedia overhead projector. The new teaching mode proves to be successful in that it has greatly improved the students' ability to use English in an all-round way and has obvious advantages over the only traditional method.展开更多
Appropriateness is very important in oral communication.By analyzing the problems in oral communication,this article puts forward some efficient ways to raise college students’awareness of appropriateness in oral com...Appropriateness is very important in oral communication.By analyzing the problems in oral communication,this article puts forward some efficient ways to raise college students’awareness of appropriateness in oral communication.展开更多
Business English is a branch of ESP(English for specific Purpose),which determines its vocational and professional orient and its focus on learning for reality,work and professions,so applying real and authentic conte...Business English is a branch of ESP(English for specific Purpose),which determines its vocational and professional orient and its focus on learning for reality,work and professions,so applying real and authentic content in Business English teaching is suggested to be helpful both in theory and in practice.However,compared with other L2 skills teaching,to some points,listening input turns out to be problematic and uncertain in terms of utilization and selection of authentic listening materials currently.This article tries to present the problems and analyze to what extent these problems can be tackled by suggesting some appropriate listening materials.展开更多
AIM: To analyze whether prompt and appropriate empirical antibiotic(AEA) use is associated with mortality in cirrhotic patients with bacteremia. METHODS: A total of 102 episodes of bacteremia in 72 patients with cirrh...AIM: To analyze whether prompt and appropriate empirical antibiotic(AEA) use is associated with mortality in cirrhotic patients with bacteremia. METHODS: A total of 102 episodes of bacteremia in 72 patients with cirrhosis were analyzed. AEA was defined as a using or starting an antibiotic appropriate to the isolated pathogen at the time of bacteremia. The primary endpoint was 30-d mortality. RESULTS: The mortality rate at 30 d was 30.4%(31/102 episodes). Use of AEA was associated with better survival at 30 d(76.5% vs 46.9%, P = 0.05), and inappropriate empirical antibiotic(IEA) use was an independent factor associated with increased mortality(OR = 3.24; 95%CI: 1.50-7.00; P = 0.003, adjusted for age, sex, ChildPugh Class, gastrointestinal bleeding, presence of septic shock). IEA use was more frequent when the isolated pathogen was a multiresistant pathogen, and when infection was healthcare-related or hospital-acquired. CONCLUSION: AEA use was associated with increased survival of cirrhotic patients who developed bacteremia. Strategies for AEA use, tailored according to the local epidemiological patterns, are needed to improve survival of cirrhotic patients with bacteremia.展开更多
To avoid the old road of urban development with high consumption and high pollution,this paper took the houses in a village near Yinchuan(a typical city of Northwest China)as an exemplary project to explore the approp...To avoid the old road of urban development with high consumption and high pollution,this paper took the houses in a village near Yinchuan(a typical city of Northwest China)as an exemplary project to explore the appropriate strategies in the arid cold climate for the sustainable development in rural undeveloped areas Northwest China.Firstly,all houses were designed according to the principles of passive solar heating.Secondly,optimized biomass energy technologies such as biogas pit and straw gasification stove were utilized for cooking or heating.Last but not the least important,the ecological building materials such as earth,straw bale,fly ash were used to construct houses,which improves the indoor thermal comfort and meanwhile lowers the negative impact on the environment.Low costs,easy accessibility and habitants' inclination were taken into account in the process of design.展开更多
AIM:To assess the appropriate use and the diagnostic yield of upper gastrointestinal endoscopy and colonoscopy in this subgroup of patients.METHODS:In total,789 consecutive outpatients referred for gastrointestinal(GI...AIM:To assess the appropriate use and the diagnostic yield of upper gastrointestinal endoscopy and colonoscopy in this subgroup of patients.METHODS:In total,789 consecutive outpatients referred for gastrointestinal(GI) endoscopy [381 for esophagogastroduodenoscopy(EGD) and 408 for colonoscopy] were prospectively enrolled in the study.The American Society for Gastrointestinal Endoscopy(ASGE) guidelines were used to assess the relationship between appropriateness and the presence of relevant endoscopic f indings.RESULTS:The overall inappropriate rate was 13.3%.The indications for EGD and colonoscopy were,respectively,appropriate in 82.7% and 82.6% of the exams,uncertain in 5.8% and 2.4% and inappropriate in 11.5% and 15%.The diagnostic yield was signif icant higher forEGDs and colonoscopies judged appropriate and uncertain when compared with those considered inappropriate(EGD:36.6% vs 36.4% vs 11.4%,P = 0.004;Colonoscopy:24.3% vs 20.0% vs 3.3%,P = 0.001).Of the 25 malignant lesions detected,all but one was detected in exams judged appropriate or uncertain.CONCLUSION:This study shows a good adherence to ASGE guidelines by the referring physicians and a significant increase of the diagnostic yield in appropriate examinations,namely in detecting neoplastic lesions.It underscores the importance that the appropriateness of the indication assumes in assuring high-quality GI endoscopic procedures.展开更多
AIM: To assess the appropriateness of referrals and to determine the diagnostic yield of colonoscopy according to the 2000 guidelines of the American Society for Gastrointestinal Endoscopy (ASGE).METHODS: A total of 7...AIM: To assess the appropriateness of referrals and to determine the diagnostic yield of colonoscopy according to the 2000 guidelines of the American Society for Gastrointestinal Endoscopy (ASGE).METHODS: A total of 736 consecutive patients (415males, 321 females; mean age 43.6±16.6 years)undergoing colonoscopy during October 2001-March2002 Were prospectively enrolled in the study. The 2000ASGE guidelines were used to assess the appropriateness of the indications for the procedure. Diagnostic yield was defined as the ratio between significant findings detected on colonoscopy and the total number of procedures performed for that indication.RESULTS: The large majority (64%) of patients had colonoscopy for an indication that was considered'generally indicated'; it was 'generally not indicated' for20%, and it was 'not listed' for 16% in the guidelines.The diagnostic yield of colonoscopy was highest for the 'generally indicated' (38%) followed by 'not listed'(13%) and 'generally not indicated' (5%) categories.In the multivariable analysis, the diagnostic yield was independently associated with the appropriateness of indication that was 'generally indicated' (odds ratio=12.3) and referrals by gastroenterologist (odds ratio = 1.9).CONCLUSION: There is a high likelihood of inappropriate referrals for colonoscopy in an open-access endoscopy system. The diagnostic yield of the procedure is dependent on the appropriateness of indication and referring physician's specialty. Certain indications 'not listed' in the guidelines have an intermediate diagnostic yield and further studies are required to evaluate whether they should be included in future revisions of the ASGE guidelines.展开更多
The cervical spine injury represents a potential devastating disease with 6% associated in-hospital mortality (lain et al., 2015). Neurological deterioration ranging from complete spinal cord injury (SCI) to incom...The cervical spine injury represents a potential devastating disease with 6% associated in-hospital mortality (lain et al., 2015). Neurological deterioration ranging from complete spinal cord injury (SCI) to incomplete SCI or single radiculopathy are potential consequences of the blunt trauma over this region. The subaxial cervical spine accounts the vast majority of cervical injuries, making up two thirds of all cervical fractures (Alday, 1996). Few classifications (Holdsworth, 1970; White et al., 1975; Mien et al., 1982; Denis, 1984; Vaccaro et al., 2007) have been proposed to describe injuries of the cervical spine for several reasons. First, to delineate the best treatment in each case; second, to determinate an accurate neurological prognosis, and third, to establish a standard way to communicate and describe specific characteristics of cervical injuries patterns. Classical systems are primarily descriptive and no single system has gained widespread use, largely because of restrictions in clinical relevance and its complexity.展开更多
文摘The Alvalade's neighborhood (Lisbon, Portugal), 1945, as a paradigm of Portuguese urbanism, can be distinguished by different housing cells that define it, as well as the different urban models, which relied on. It is possible to identify distinct occupational stains within the neighborhood, specifically in the cell one in this article, as a pioneer construction, due to housing dimension that corresponds to different housing typologies, residents and daily use areas, equipment. The objective is therefore, to understand how these three factors are reflected inside the cell, managing occupational stains which differ in space appropriation. How those different occupational stains that derive from the housing and urban morphology, may result in the occupation and experience of its inhabitants, not invalidating a cohesive structure of the neighborhood?
文摘Background: Workers spend a significant amount of time in the workspace. Involvement of a spouse in a doctor’s workplace can take different forms and come with different intentions. Objectives: The survey aimed to determine the prevalence and extent of spousal involvement in physicians’ workplaces as well as the outcome of such involvement on doctor’ swell-being, productivity, and relationship with colleagues. Methods: This cross-sectional online survey on spousal involvement in the workplace of doctors was conducted among 83 responding doctors from July to August 2023. Results: Among the respondents, 60 (72.3%) had witnessed a doctor’s spouse being involved in the workplace. The most common reason for spousal involvement in the workplace was to protect the spouse from what they perceived as a threat 34 (54.0%). Spouse’s ignorance of boundaries in the workplace (OR: 6.09 (95% CI: 1.70, 21.79) P: 0.003) and exertion of control by the spouse (OR: 11.2 (95% CI: 2.26, 56.41) P: 0.002) were significantly associated with higher odds of inappropriate spousal involvement in the workplace, while expression of love for spouse with acts of kindness was significantly associated with a lowered odd of inappropriate spousal involvement (OR: 0.11 (95% CI: 0.03, 0.36) P: 0.0001). Conclusion: Spousal involvement in the workplace is relatively common. Ignorance of the boundaries of the workplace and exertion of control by the spouse were significant enablers of inappropriate spousal involvement in the workplace of doctors. The establishment of workplace policies that define the limits of spousal involvement in the doctor’s workplace can foster a healthy workspace environment, enhance doctors’ well-being, and improve patient care.
文摘Background: Use of inappropriate amikacin dose is one of the most important factors in inducing toxicity, prolonged hospitalization as well as in increasing patient’s mortality. Objective: The aims of this study are the analysis of amikacin dose, serum level and the examination of the effectiveness of the clinical pharmacologist (CP) therapeutic drug monitoring (TDM) intervention to guarantee the safety of amikacin use. Methods: This is a one-year retrospective observational chart review study, which evaluates amikacin dose, serum drug level, development of adverse effects in patients on amikacin with or without CP TDM consultation. Results: Amikacin was prescribed for 393 complex patients, with median age 83. Amikacin group (AG) included 140 (32%) courses with CP consultation (AG1) and 292 (68%) courses without CP consultation (AG2). The distribution of most study characteristics in both groups was similar including amikacin dose (9-10 mg/kg/day), renal failure (14%) and mortality (12%). Acceptance for CP consultation was in 46% of amikacin courses and dose changes were done in 63% after CP intervention. Prolonged antibiotic course (4.6 ± 1.5 vs 3.8 ± 1.6 days, p < 0.0001) and the patient’s hemodynamic instability (15% vs 7%, p = 0.01) were more frequent in the AG1 compared to the AG2. There was a strong association between CP consultation and prolonged hospitalization (p = 0.005), while no association between it and amikacin adverse effects, renal failure or mortality. Conclusions: There was no trend to reducing amikacin toxicity, days of hospitaliza tion or mortality in patients with CP consultation. CP TDM intervention was more in the management of complicated clinical situations. However, it is necessary to optimize it.
文摘The accelerating urbanization process leads to aggravated environmental problems, thus garden design which is a creative activity connecting human and nature has attracted much attention, and also garden designers have had to rethink about environmental ethics and morals. This study, from the perspective of environmental ethics, duly proposed the brand-new concept of 'appropriate garden of primitive ecology', proceeded from the orientation, form, value, theoretical basis, realistic significance, culture and consumption psychology of 'garden of primitive ecology', fully developed outstanding ecological wisdoms and morals in traditional Chinese garden culture, boosted garden designs to the environmental ethics level of eco-justice, to seek for the approach to 'garden of primitive ecology' with indigenous Chinese environmental ethic characteristics.
文摘Based on the constructivism, using the College English(new edition) CD-ROMs for classroom teaching as main media, this paper explores the feasibility of the classroom teaching mode of appropriate combination of traditional methods with the multimedia overhead projector. The new teaching mode proves to be successful in that it has greatly improved the students' ability to use English in an all-round way and has obvious advantages over the only traditional method.
文摘Appropriateness is very important in oral communication.By analyzing the problems in oral communication,this article puts forward some efficient ways to raise college students’awareness of appropriateness in oral communication.
文摘Business English is a branch of ESP(English for specific Purpose),which determines its vocational and professional orient and its focus on learning for reality,work and professions,so applying real and authentic content in Business English teaching is suggested to be helpful both in theory and in practice.However,compared with other L2 skills teaching,to some points,listening input turns out to be problematic and uncertain in terms of utilization and selection of authentic listening materials currently.This article tries to present the problems and analyze to what extent these problems can be tackled by suggesting some appropriate listening materials.
文摘AIM: To analyze whether prompt and appropriate empirical antibiotic(AEA) use is associated with mortality in cirrhotic patients with bacteremia. METHODS: A total of 102 episodes of bacteremia in 72 patients with cirrhosis were analyzed. AEA was defined as a using or starting an antibiotic appropriate to the isolated pathogen at the time of bacteremia. The primary endpoint was 30-d mortality. RESULTS: The mortality rate at 30 d was 30.4%(31/102 episodes). Use of AEA was associated with better survival at 30 d(76.5% vs 46.9%, P = 0.05), and inappropriate empirical antibiotic(IEA) use was an independent factor associated with increased mortality(OR = 3.24; 95%CI: 1.50-7.00; P = 0.003, adjusted for age, sex, ChildPugh Class, gastrointestinal bleeding, presence of septic shock). IEA use was more frequent when the isolated pathogen was a multiresistant pathogen, and when infection was healthcare-related or hospital-acquired. CONCLUSION: AEA use was associated with increased survival of cirrhotic patients who developed bacteremia. Strategies for AEA use, tailored according to the local epidemiological patterns, are needed to improve survival of cirrhotic patients with bacteremia.
基金Supported by National Key Technology R&D Programin the 11th Five Year Plan of China(2006BAJ04A18)
文摘To avoid the old road of urban development with high consumption and high pollution,this paper took the houses in a village near Yinchuan(a typical city of Northwest China)as an exemplary project to explore the appropriate strategies in the arid cold climate for the sustainable development in rural undeveloped areas Northwest China.Firstly,all houses were designed according to the principles of passive solar heating.Secondly,optimized biomass energy technologies such as biogas pit and straw gasification stove were utilized for cooking or heating.Last but not the least important,the ecological building materials such as earth,straw bale,fly ash were used to construct houses,which improves the indoor thermal comfort and meanwhile lowers the negative impact on the environment.Low costs,easy accessibility and habitants' inclination were taken into account in the process of design.
文摘AIM:To assess the appropriate use and the diagnostic yield of upper gastrointestinal endoscopy and colonoscopy in this subgroup of patients.METHODS:In total,789 consecutive outpatients referred for gastrointestinal(GI) endoscopy [381 for esophagogastroduodenoscopy(EGD) and 408 for colonoscopy] were prospectively enrolled in the study.The American Society for Gastrointestinal Endoscopy(ASGE) guidelines were used to assess the relationship between appropriateness and the presence of relevant endoscopic f indings.RESULTS:The overall inappropriate rate was 13.3%.The indications for EGD and colonoscopy were,respectively,appropriate in 82.7% and 82.6% of the exams,uncertain in 5.8% and 2.4% and inappropriate in 11.5% and 15%.The diagnostic yield was signif icant higher forEGDs and colonoscopies judged appropriate and uncertain when compared with those considered inappropriate(EGD:36.6% vs 36.4% vs 11.4%,P = 0.004;Colonoscopy:24.3% vs 20.0% vs 3.3%,P = 0.001).Of the 25 malignant lesions detected,all but one was detected in exams judged appropriate or uncertain.CONCLUSION:This study shows a good adherence to ASGE guidelines by the referring physicians and a significant increase of the diagnostic yield in appropriate examinations,namely in detecting neoplastic lesions.It underscores the importance that the appropriateness of the indication assumes in assuring high-quality GI endoscopic procedures.
文摘AIM: To assess the appropriateness of referrals and to determine the diagnostic yield of colonoscopy according to the 2000 guidelines of the American Society for Gastrointestinal Endoscopy (ASGE).METHODS: A total of 736 consecutive patients (415males, 321 females; mean age 43.6±16.6 years)undergoing colonoscopy during October 2001-March2002 Were prospectively enrolled in the study. The 2000ASGE guidelines were used to assess the appropriateness of the indications for the procedure. Diagnostic yield was defined as the ratio between significant findings detected on colonoscopy and the total number of procedures performed for that indication.RESULTS: The large majority (64%) of patients had colonoscopy for an indication that was considered'generally indicated'; it was 'generally not indicated' for20%, and it was 'not listed' for 16% in the guidelines.The diagnostic yield of colonoscopy was highest for the 'generally indicated' (38%) followed by 'not listed'(13%) and 'generally not indicated' (5%) categories.In the multivariable analysis, the diagnostic yield was independently associated with the appropriateness of indication that was 'generally indicated' (odds ratio=12.3) and referrals by gastroenterologist (odds ratio = 1.9).CONCLUSION: There is a high likelihood of inappropriate referrals for colonoscopy in an open-access endoscopy system. The diagnostic yield of the procedure is dependent on the appropriateness of indication and referring physician's specialty. Certain indications 'not listed' in the guidelines have an intermediate diagnostic yield and further studies are required to evaluate whether they should be included in future revisions of the ASGE guidelines.
文摘The cervical spine injury represents a potential devastating disease with 6% associated in-hospital mortality (lain et al., 2015). Neurological deterioration ranging from complete spinal cord injury (SCI) to incomplete SCI or single radiculopathy are potential consequences of the blunt trauma over this region. The subaxial cervical spine accounts the vast majority of cervical injuries, making up two thirds of all cervical fractures (Alday, 1996). Few classifications (Holdsworth, 1970; White et al., 1975; Mien et al., 1982; Denis, 1984; Vaccaro et al., 2007) have been proposed to describe injuries of the cervical spine for several reasons. First, to delineate the best treatment in each case; second, to determinate an accurate neurological prognosis, and third, to establish a standard way to communicate and describe specific characteristics of cervical injuries patterns. Classical systems are primarily descriptive and no single system has gained widespread use, largely because of restrictions in clinical relevance and its complexity.