Spousal Involvement in the Workplace of Doctors: What Is Defined as Appropriate or Inappropriate

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.

Appropriateness of Amikacin Dose Prescription, Monitoring and Safety during Hospitalization as an Impact of Clinical Pharmacologist Intervention, in the Israeli Regional Hospital

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.

Appropriate Garden Design of Primitive Ecology Based on the Indigenization of Environmental Ethics

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.

Expression of Humanity in Highway Landscape Design

Creation of human landscape is the important component of highway landscape design,which has incomparable advantage in the aspects of transmitting cultural atmosphere and expressing regional features.It can not only beautify highway environment,but also serve for traffic function.It is another effective approach to ensure traffic safety.The paper has analyzed existing problems and insufficiencies of modern highway human construction,and discussed the means and methods of expression of historical humanized landscape in highway landscape design.The paper has considered that during design of highway human landscape,it should fully explore historical and humanized background along the highway,extract cultural spirit,enrich cultural connotation,and oppose coarse and fictitious design on the basis of respecting culture and history.

Effect of conceptual fluency on English oral communication

Recent research has found that L2 learners of high grammatical proficiency will not necessarily show concomitant pragmatic skills. On the basis of Danesi＇s Conceptual Fluency theory and actual learners＇ oral abilities, this research conducted two types of tests： a discourse-completion test and a dialogue-interpretation test. The research has found that L2 learners are often influenced by L1 conceptual system, and speeches are not necessarily appropriate and native-like.

The Experimental Research on the Classroom Teaching Mode of Appropriate Combination of Traditional Methods with the Multimedia Overhead Projector

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.

Chinese-English Translation of Advertisements

This paper is on the Chinese-English advertisement translation. It gives people an orderly discussion with examples in three parts:the problems in current advertisement translation, the causes of these problems, essential steps of making the Chinese-English translation of advertisement onto an appropriate way. This paper also suggests the principles of Chinese-English advertisement translation:natural, precise and understandable.

The Effect of Self-confidence in SLA

Krashen's affective filter theory drew researchers' attention to the fresh field of internal factors of learners.But researchers seem to pay too much attention to the other factors while tending to neglect a factor that we cannot afford to play down in language learning research-self-confidence.This paper is designed to discuss the close relationship between self-confidence and some of the other important affective factors,and furthermore raise appropriate concern over self-confidence.

我国慢性病防治人员素质分析

目的分析我国31个省(自治区、直辖市)慢性病防治人员素质及变化趋势,探讨我国慢性病防治人员素质的区域差异、变化原因及提升建议。方法收集1995—2017年所有涉及我国各省(自治区、直辖市)慢性病防治人力资源的文献,摘录慢性病防治人员素质的相关表述,综合计算慢性病防治人员素质适宜程度,描述2000—2017年我国各省(自治区、直辖市)慢性病防治人员素质的现状及变化趋势。结果从全国来看,2017年我国慢性病防治人员素质适宜程度的平均水平为40.3%,与适宜标准(85.0%)相差52.6%。从各省(自治区、直辖市)来看,东部地区慢性病防治人员的素质较高(适宜程度为42.3%),中西部地区慢性病防治人员素质的适宜程度在36.0%左右。2000—2017年我国各省(自治区、直辖市)慢性病防治人员素质大幅提升,适宜程度的平均水平提升了417.6%。结论我国慢性病防治人员素质存在区域差异。2000年以来防治人员素质稳步提升,但距适宜标准仍有较大差距。建设高素质慢性病防治人才队伍任重道远。

中医药适宜技术推广协同治理机制构建研究

目的通过构建中医药适宜技术推广协同治理机制,增强群众对中医药适宜技术的接受度,为进一步提升中医药适宜技术推广应用的力度与深度提供参考。方法梳理中医药适宜技术相关政策,运用协同治理理论,从协同驱动主体、制度保障、服务资源3个维度思考中医药适宜技术推广协同运转机制。结果结合协同驱动主体、制度保障、服务资源3个维度的要素,构建横向联动、纵向同质化执行的中医药适宜技术推广协同治理机制。结论基于协同驱动主体、制度保障、服务资源3个维度构建的中医药适宜技术推广协同治理机制,对于提高中医药适宜技术的普及性、满足基层群众多元化多层次健康需求具有现实意义。

Ways to Develop College Students' Awareness of Appropriateness in Oral Communication

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.

Appropriate Listening Materials in Business English Teaching

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.

我国公立医院财政拨款收入的结构变动特征分析

目的 分析公立医院财政拨款收入的结构变动特征。方法 基于2011—2020年将考察时间段调整为2010—2019年《中国卫生健康统计年鉴》的数据,应用结构变动度分析方法。结果 2010—2019年,全国公立医院的财政拨款收入规模呈现逐年上升的趋势。我国不同级别公立医院的财政拨款结构变动贡献率从大到小依次为三级医院(58.43%)、二级医院(39.26%)、基层医疗卫生机构(2.31%)。各类公立医院的贡献率从大到小依次为精神病医院(40.25%)、综合医院(17.13%)、传染病医院(14.64%)、中医(民族)医院(7.85%)、儿童医院(6.00%)、妇产医院/妇幼保健院(5.35%)、其他专科医院(4.90%)、职业病防治院(3.88%)。结论 需要政府落实职责,在财政拨款安排中重视各类型、各级别公立医院的合理平衡,科学规划财政投入标准及支持力度,进一步推动分级诊疗制度,保证不同类型、级别医院的平稳运行。

Damage control orthopaedics: State of the art

Damage control orthopaedics(DCO) originally consisted of the provisional immobilisation of long bone-mainly femur-fractures in order to achieve the advantages of early treatment and to minimise the risk of complications, such as major pain, fat embolism, clotting, pathological inflammatory response, severe haemorrhage triggering the lethal triad, and the traumatic effects of major surgery on a patient who is already traumatised(the "second hit" effect). In recent years, new locations have been added to the DCO concept, such as injuries to the pelvis, spine and upper limbs. Nonetheless, this concept has not yet been validated in well-designed prospective studies, and much controversy remains.Indeed, some researchers believe the indiscriminate application of DCO might be harmful and produce substantial and unnecessary expense. In this respect, too,normalised parameters associated with the acid-base system have been proposed,under a concept termed early appropriate care, in the view that this would enable patients to receive major surgical procedures in an approach offering the advantages of early total care together with the apparent safety of DCO. This paper discusses the diagnosis and treatment of severely traumatised patients managed in accordance with DCO and highlights the possible drawbacks of this treatment principle.

Maize response to elevated plant density combined with lowered N-fertilizer rate is genotype-dependent

Increasing plant density and improving N fertilizer rate along with the use of high density-tolerant genotypes would lead to maximizing maize(Zea mays L.) grain productivity per unit land area. The objective of this investigation was to match the functions of optimum plant density and adequate nitrogen fertilizer application to produce the highest possible yields per unit area with the greatest maize genotype efficiency. Six maize inbred lines differing in tolerance to low N and high density(D) [three tolerant(T); L-17, L-18, L-53,and three sensitive(S); L-29, L-54, L-55] were chosen for diallel crosses. Parents and crosses were evaluated in the 2012 and 2013 seasons under three plant densities: low(47,600),medium(71,400), and high(95,200) plants ha-1and three N fertilization rates: low(no N addition), medium(285 kg N ha-1) and high(570 kg N ha-1). The T × T crosses were superior to the S × S and T × S crosses under the low N–high D environment in most studied traits across seasons. The relationships between the nine environments and grain yield per hectare(GYPH) showed near-linear regression functions for inbreds L54, L29, and L55 and hybrids L18 × L53 and L18 × L55 with the highest GYPH at a density of47,600 plants ha-1and N rate of 570 kg N ha-1and a curvilinear relationship for inbreds L17, L18, and L53 and the rest of the hybrids with the highest GYPH at a density of95,200 plants ha-1combined with an N rate of 570 kg N ha-1. Cross L17 × L54 gave the highest grain yield in this study under both high N–high-D(19.9 t ha-1) and medium N–high-D environments(17.6 t ha-1).

A study on service capacity of primary medical and health institutions for cervical cancer screening in urban and rural areas in China

Objective: To provide a decision-making basis for sustainable and effective development of cervical cancer screening.Methods: This cross-sectional study assesses the service capacity to conduct cervical cancer screening with a sample of 310 medical staff, medical institutions and affiliated township health centers from 20 countylevel/district-level areas in 14 Chinese provinces in 2016.Results: The county-level/district-level institutions were the main prescreening institutions for cervical cancer screening. More medical staff have become engaged in screening, with a significantly higher amounts in urban than in rural areas(P<0.05). The number of human papillomavirus(HPV) testers grew the fastest(by 225% in urban and 125% in rural areas) over the course of the project. HPV testing took less time than cytology to complete the same number of screening tasks in both urban and rural areas. The proportion of mid-level professionals was the highest among the medical staff, 40.0% in urban and 44.7% in rural areas(P=0.406), and most medical staff had a Bachelor’s degree, accounting for 76.3% in urban and 52.0% in rural areas(P<0.001). In urban areas, 75.0% were qualified medical staff, compared with 68.0% in rural areas, among which the lowest proportion was observed for rural cytology inspectors(22.7%). The medical equipment for cervical pathology diagnosis in urban areas was better(P<0.001). HPV testing equipment was relatively adequate(typing test equipment was 70% in urban areas, and non-typing testing equipment was 70% in rural areas).Conclusions: The service capacity of cervical cancer screening is insufficient for the health needs of the Chinese population. HPV testing might be an optimal choice to fill the needs of cervical cancer screening given current Chinese medical health service capacity.

Appropriate Strategies for Rural Houses In Northwest China

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.

Appropriate empirical antibiotic use and 30-d mortality in cirrhotic patients with bacteremia

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.

Appropriateness of indication and diagnostic yield of colonoscopy: First report based on the 2000 guidelines of the American Society for Gastrointestinal Endoscopy

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.

Subaxial cervical spine injury classification system: is it most appropriate for classifying cervical injury?

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.