住院医师规范化培训Self-study模式的实践与探索

参考美国毕业后医学教育认证委员会(ACGME)住院医师6大核心能力和加拿大皇家内外科学院(The Royal College of Physicians and Surgeons of Canada)Can MEDS住院医师能力框架的住院医师规范化培训评价指标所设立的住院医师规范化培训Self-study方法,以各联盟医院的住院医师规范化培训管理机构及内科、外科、全科、麻醉科、医学影像科住院医师规范化培训专业基地为评估对象。评估内容:涉及管理机构标准及专业基地项目标准的各评估指标共计140项。对140个评估项目开展现况调研、缺陷查找、设定目标、持续改进的自我评估流程,旨在探讨Self-study模式在住院医师规范化培训中的实践与效果。评估结果显示:在140项评估指标中,完全达标的为132项,部分达标需要完善的有5项,未达标需要计划启动的有3项,总体达标率为94.3%。通过本次Self-study的自我评估发现:中国的住院医师规范化培训急需建立一整套既与国际接轨又符合我国国情的住院医师规范化培训质量控制与综合评估体系。

Analysis on Factors Influencing Sustainable Development of Self-study Examination of Agricultural Science Disciplines

Based on existing problems in the course of development of self-study examination of agricultural science disciplines, this paper analyzes logical conditions for its sustainable development. Major logical conditions include requirement for free and comprehensive development of individuals; requirement for social institutional evolution and change; requirement for fairness and justice of education and development; as well as requirement for better-established organization system and higher social reputation. Finally, it presents basic measures for sustainable development of self-study examination of agricultural science disciplines, including carrying on reasonable core elements of self-study examination system, adjusting structure of discipline, improving social assistance system, and expanding service space.

Online Case Based Self-Study Modules as an Adjunct Learning Tool in Otorhinolaryngology: A Pilot Study

Background/Need for innovation: Undergraduate students in Otolaryngology are on the lookout for easy modes of learning which can help them understand concepts better as well as score more in examinations. A need was hence felt to introduce a new learning resource to supplement traditional teaching-learning methods. Methods: Digital, case based self–study modules were prepared using all open source technology and validated by experts in the specialty. The modules were uploaded on a website specifically created for the purpose. They were pilot tested on twenty consenting third year undergraduate (MBBS) students using a crossover design. Post test comprising of multiple choice questions was administered to the students after a period of two weeks. Feedback was obtained from faculty and students. Results: Test scores were found to be significantly higher amongst students who used the learning modules as a supplement to regular bedside teaching (p < 0.001;Wilcoxon signed rank test). Majority of students agreed that the modules helped them gain confidence during internal assessment examinations and would help revision. Conclusions: Online, case based, self-study modules helped students to perform better when used as a supplement to traditional teaching methods. Students agreed that it enabled easy understanding of subject and helped them gain confidence.

Factors Affecting the English Self-study of Senior High Students

The new students'view appeals for learning alone,so the teachers should make study for students,which is the order of the new curriculum standards of the high school English.There are many strategies to improve that,but the effect of self-study is not satisfactory.In order to make it come into effects,we should conclude the factors affecting the English self-study.Subjective and objective aspects will be concluded according to the literature review,investigation,self-experience and features of senior high English study.

角色游戏促进中班幼儿社会自立-安全常识发展的个案研究

为探究角色游戏对中班幼儿社会自立-安全常识发展的作用,研究采用单被试A-B实验设计,选取3名社会自立-安全常识发展水平较低的中班幼儿为被试,通过角色游戏对其社会自立-安全常识进行干预。结果表明:角色游戏能够促进中班幼儿社会自立-安全常识的发展,三名个案在干预期和追踪期的社会自立-安全常识均高于基线期。结论:角色游戏能有效提高幼儿的社会自立-安全常识水平。教师和家长可以通过角色游戏培养幼儿的社会自立-安全常识,促进幼儿的安全常识养成和独立自主性发展。

An Observational Study of the 30-50 Day Atmospheric Oscillations Part I: Structure and Propagation

Features of structure and propagation of the 30 to SO day atmospheric oscillations are investigated using the ECMWF analysis of 1980-1983. Evidence is provided to confirm the characteristics of the oscillation in the equatorial region. Those in the mid-high latitudes, however, are revealed to be very different from the tropics and pose a strong barotropic structure. Horizontal coherence shows teleconnection patterns which can be identified as EAP and PNA. The wind field of the specified time scale of the oscillation appears as long-lived vortices and vortex pairs. Mid-latitude perturbations propagate clearly westwards, especially during the winter season. In the high latitudes, they propagate westwards in the winter but eastwards in the summer. Meridional propagations are rather different from region to region.

Potential Toxicological and Cardiopulmonary Effects of PM2,5 Exposure and Related Mortality:Findings of Recent Studies Published during 2003-2013

Air pollution has environmental issue owing become a serious to its diverse harmful effects on the physical and biological environment. According to the Environmental Protection Agency （EPA） and the World Health Organization （WHO）, air pollution affects millions of people worldwide. Hundreds of thousands of deaths each year and a range of diseases, particularly among vulnerable groups （i.e., children, the elderly, and people with special medical conditions）, are attributed to air pollution. These effects are not always caused by single pollutant in the air; rather, they are considered consequences of the multi-pollutants to which people are simultaneously exposed.

Numerical study on three-dimensional flow field of continuously rotating detonation in a toroidal chamber

Gaseous detonation propagating in a toroidal chamber was numerically studied for hydrogen/oxygen/nitrogen mixtures. The numerical method used is based on the three-dimensional Euler equations with detailed finiterate chemistry. The results show that the calculated streak picture is in qualitative agreement with the picture recorded by a high speed streak camera from published literature. The three-dimensional flow field induced by a continuously rotating detonation was visualized and distinctive features of the rotating detonations were clearly depicted. Owing to the unconfined character of detonation wavelet, a deficit of detonation parameters was observed. Due to the effects of wall geometries, the strength of the outside detonation front is stronger than that of the inside portion. The detonation thus propagates with a constant circular velocity. Numerical simulation also shows three-dimensional rotating detonation structures, which display specific feature of the detonation- shock combined wave. Discrete burning gas pockets are formed due to instability of the discontinuity. It is believed that the present study could give an insight into the interest- ing properties of the continuously rotating detonation, and is thus beneficial to the design of continuous detonation propulsion systems.

An Observational Study of the 30-50 Day Atmospheric Oscillations Part II: Temporal Evolution and Hemispheric Interaction across the Equator

In this part, the temporal evolution and interaction across the equator of 30-50 day oscillation in the atmosphere are investigated further. The annual variation of 30-50 day oscillation is quite obvious in the mid-high latitudes. In the tropical atmosphere, the obvious interannual variation is an important property for temporal evolution of 30-50 day oscillation. The low-frequency wavetrain across the equator over the central Pacific and central Atlantic area, the movement of the long-lived low-frequency system across the equator and the meridional wind component across the equator will obviously show the interaction of 30-50 day oscillation in the atmosphere across the equator.

Experimental Study on Momentum Transfer of Surface Texture in Taylor-Couette Flow

The behavior of Taylor-Couette （TC） flow has been extensively studied. However, no suitable torque prediction models exist for high-capacity fluid machinery. The Eckhardt-Grossmann-Lohse （EGL） theory, derived based on the Navier-Stokes equations, is proposed to model torque behavior. This are the significant energy theory suggests that surfaces transfer interfaces between cylinders and annular flow. This study mainly focuses on the effects of surface texture on momentum transfer behavior through global torque measurement. First, a power-law torque behavior model is built to reveal the relationship between dimensionless torque and the Taylor number based on the EGL theory. Second, TC flow appa- ratus is designed and built based on the CNC machine tool to verify the torque behavior model. Third, four surface texture films are tested to check the effects of surface texture on momentum transfer. A stereo microscope and three-dimensional topography instrument are employed to analyze surface morphology. Global torque behavior is measured by rotating a multi component dynamometer, and the effects of surface texture on the annular flow behavior are observed via images obtained using a high-speed camera. Finally, torque behaviors under four differentsurface conditions are fitted and compared. The experi- mental results indicate that surface textures have a remarkable influence on torque behavior, and that the peak roughness of surface texture enhances the momentum transfer by strengthening the fluctuation in the TC flow.

A Numerical Study on Ship Self propulsion Factor

The scale effect on self propulsion factor is studied numerically in this paper.Model scale and full scale ship computation are conducted as test case.The flow field around ship hull is simulated by solving 3 D RANS equation and two equation turbulence model.The propeller is modeled by force disc and its loading coefficient is investigated by lifting surface method.The comparison between model test and prediction is made.

36-Month Follow-Up Study of Post-Intervention Chronic Heart Failure Patients

Aim: Although numerous studies of disease management and case management of chronic heart failure (CHF) have been carried out, length of effectiveness after program commencement has not been examined, so we examined a follow-up study at 36 months after program commencement. Methods: Participants went for follow-up visits to one Japanese clinic which specializes in internal cardiovascular medicine and they were given diagnoses of CHF. 104 outpatients participated in this study and randomized control trial was implemented. An educational program was implemented for 6 months. The data were collected at baseline, 3, 6, 9, 12 months from both intervention and control groups and at 24 and 36 months from the intervention group. Results: There was significant improvement in New York Heart Association (NYHA) in the intervention group between baseline and 36 months. Improvement in weight monitoring and activities or exercise in the intervention group continued up to 36 months. Meanwhile, sodium restricted diets and quitting smoking and/or drinking depended on individual preference and it was difficult to make improvements in these areas. Conclusions: The educational program showed promise in preventing CHF outpatients from deteriorating significantly on a long-term basis as self-monitoring of activity and weight continued significantly and there were no participants with CHF who deteriorated in the intervention group at 36 months after program commencement, although the program aimed only to provide illness and self-management knowledge. On the other hand, future work will need to compare participants in this program to a control group over an extended period of time with consideration for relieving the burden of the control group.

Parameter Self - Learning of Generalized Predictive Control Using BP Neural Network

This paper describes the self—adjustment of some tuning-knobs of the generalized predictive controller(GPC).A three feedforward neural network was utilized to on line learn two key tuning-knobs of GPC,and BP algorithm was used for the training of the linking-weights of the neural network.Hence it gets rid of the difficulty of choosing these tuning-knobs manually and provides easier condition for the wide applications of GPC on industrial plants.Simulation results illustrated the effectiveness of the method.

Self - Crosslinking Behavior of Self - Emulsion Water - Based Polyure-thane Coating Agents

The relation between structures and properties of polyurethane are investigated by modern physical and chemical methods.The results obtained are as follows:the effects of the content of self-crosslinking agent on the properties of polyurethane,i.e.,dispersion stability,dynamical viscoelasticity and mechanical properties are discussed.It is found that the optimum molar ratio of epichlorohydrin and diethylenetriamine is 1:2.A mois-

Culture Self- Consciousness in Transmission of Chinese Philosophy from the Perspective of English Globalization -- Taking the Belt and Road Initiative for Example

The Belt and Road Initiative contains the aspiration of Chinese nation to pursue ideological freedom and desire of strengthening international exchanges and cooperation. This paper takes the Belt and Road Initiative for example,emphasizing the interpretation of the inheritance and development of Chinese culture so as to study the importance of Culture Self-Consciousness in Chinese Philosophy,in the context of English globalization. That is to say,this paper stresses the spirits and the stand of nation 's demonstration on pursuing peace,cooperation and sustainable development in the civilization continuity from traditional China to the contemporary China,with practical philosophic view.

Preparation and spectroscopic, and thermal decomposition kinetic studies of europium(Ⅲ) complex [Eu(HNBD)_3] (HNBD: 1-(6-hydroxy-1-naphthyl)-1,3-butanedione)

The complex of Eu（IH） with 1-（6-hydroxy- 1-naphthyl）- 1,3-butanedione （HNBD） was prepared for the first time and characterized by elemental analysis, IR, UV, fluorescence spectrum, and DTA-TG-DTG techniques. The IR and UV-visible spectra showed that Eu（Ⅲ） ion was coordinated to the HNBD ligand. The fluorescence spectrum showed the presence of Eu^3＋ characteristic emission. The TG-DTA-DTG curves showed that the thermal decomposition of the anhydrous complex was a two-stage process and the final residue was Eu2O3. The thermal decomposition kinetic parameters of the complex were evaluated from TG-DTG data by using three kinds of integral methods （Coat-Redfem equation, Horowitz and Metzger equation, Madhusudanan-Krishnan-Ninan equation）. The kinetic parameters of the first stage are E^＊ = 164.02 kJ.moll, A = 1.31 × 10^15 s^-l, AS^＊= 42.27 J·K^-l·mol^-l, △H^＊ = 159.51 kJ·mol^-l, △G^＊= 136.54 kJ·mol^-l, and n = 3.1, those of the second stage are E^＊= 128.52 kJ·mol^-l, A = 1.44× 106 s^-1, △S^＊= - 136.89 J·K^-l·mol^-l, △H^＊ = 120.41 kJ·mol^-l, △G^＊= 283.85 kJ·mol^-l, and n = 1.1.

Study on the Mercury （11） Complex of 4,5-benzol,2-dithiole-3-thione by IR, Theoricaly and X-Ray

A mercury （II） complex with 4.5-benzo-1.2-dithiol-3-thione （C7H4S3） （1）, [Hg2I4（C7H4S3）2] （2） was synthesized. The structure of the obtained complex （2） was characterized by crystallography, Infrared Spectroscopy （IR） analysis and theoretical study. The complex （2） has a dimeric structure, where each mercury atom takes a tetrahedral geometry and is coordinated by two bridging chloride, one terminal chloride and one thiocarbonyl sulfur atom （C=S） of the ligand.

拮抗剂方案用于前次IVF/ICSI-ET失败卵巢储备功能减退患者的自身对照研究

目的探讨拮抗剂方案用于前一周期激动剂方案促排卵助孕失败的卵巢储备功能减退(DOR)不孕症患者的临床结局。方法回顾性分析2019年1月至2023年6月在我院生殖医学中心接受IVF/ICSI-ET治疗的69例DOR患者的临床资料,第一周期使用激动剂方案(包括黄体期长方案或卵泡期长方案)促排卵助孕失败,第二周期改用拮抗剂方案促排卵。采用自身对照的研究方法比较前后两个周期的助孕结局。结果前后两个周期间的Gn天数、Gn总量、扳机日E 2及P水平、扳机日子宫内膜厚度、扳机日直径≥14 mm卵泡数比较均无显著性差异(P>0.05)。第二周期的扳机日LH水平显著高于第一周期[(2.42±1.83)U/L vs.(1.77±1.40)U/L,P<0.05];第二周期的获卵数[(6.80±3.56)枚vs.(5.45±3.83)枚]、MⅡ卵数[(5.59±3.15)枚vs.(3.91±3.48)枚]、受精率(76.03%vs.61.87%)、2PN率(67.97%vs.53.07%)、D3优质胚胎数[(2.61±2.40)枚vs.(1.25±1.57)枚]及囊胚形成率(44.44%vs.33.56%)均显著高于第一周期(P<0.05);前后两周期的2PN卵裂率、优质囊胚形成率比较无显著性差异(P>0.05)。前后两周期的周期取消率和鲜胚移植异位妊娠率比较无显著性差异(P>0.05);第二周期鲜胚移植的HCG阳性率(45.65%vs.18.18%)和临床妊娠率(36.96%vs.12.73%)显著高于第一周期(P<0.05),流产率显著低于第一周期(11.76%vs.85.71%,P<0.05)。结论对于第一周期使用激动剂方案促排卵助孕失败的DOR患者,第二周期采用拮抗剂方案促排卵可以提高获卵数和优质胚胎数,有利于改善患者的临床结局。

肺癌根治术后患者自我管理效能感与运动依从性的关系-交叉滞后分析

目的探讨术后6个月内肺癌根治术后患者自我管理效能感与运动依从性的变化趋势,并分析二者间的预测关系,为改善术后患者运动依从性提供参考。方法采用便利抽样法,选取2022年12月至2023年5月南充市2所三级甲等综合医院胸外科首次行肺癌根治术的188例患者作为研究对象,采用中文版癌症自我管理效能感量表(Chinese-version strategies used by people to promote health,C-SUPPH)、运动依从性量表调查患者出院前1d(TI)与术后1个月(T2)、3个月(T3)、6个月(T4)的自我管理效能感及运动依从性水平,构建交叉滞后模型分析自我管理效能感与运动依从性间的因果关系。结果178例患者完成研究;术后6个月内,肺癌根治术后患者自我管理效能感、运动依从性均呈先上升后下降趋势(均P<0.05);交叉滞后模型显示,术后早期(TI~T2)患者自我管理效能感与运动依从性互为因果(β=0.254,P=0.003;β=0.332,P=0.007);中期(T2~T3)患者自我管理效能感能正向预测运动依从性(β=0.286,P<0.001);后期(T3~T4)两者不能相互预测(均P>0.05)。结论肺癌根治术后患者自我管理效能感处于中等水平、运动依从性处于低水平;肺癌根治术后患者自我管理效能感、运动依从性的初始水平并不代表长期治疗后的变化趋势,两者间的预测关系也会发生改变。医护人员需考虑其动态变化特征和个体差异,在患者术后的各个阶段进行评估,及时给予针对性的干预。

Self-Rated Health in University Students from Rio Branco in the Western Brazilian Amazon

The objective of this study was to determine the prevalence and associated factors of unsatisfactory self-rated health in university students. A cross-sectional study was conducted in graduate students of a Public University in the city of Rio Branco in the Western Brazilian Amazon. The overall prevalence of unsatisfactory self-rated health was 23.0%. After adjusting for gender and age, the factors associated with unsatisfactory self-rated health were as follows: sedentarism during leisure time (prevalence ratio (PR): 2.26;95% CI: 1.56 - 3.29), consuming meals only in restaurants (PR: 1.48;95% CI: 1.14 - 1.94), insomnia (PR: 1.86;95% CI: 1.50 - 2.30), headaches (PR: 2.17;95% CI: 1.52 - 3.09), and back pain (PR: 2.03;95% CI: 1.58 - 2.60). Thus, a high prevalence of unsatisfactory self-rated health was identified in this group of university students. The findings suggest immediate implementation of programs to promote healthy behaviors and to prevent headaches, back pain and insomnia.