《证据学》多媒体CAI课件的制作

本文叙述了利用计算机多媒体技术开发教学课件的过程和方法,着重介绍了本课件设计思想、课件的组成及如何利用多媒体制作工具将多媒体素材编制成教学课件。

一部与时俱进、开拓创新的证据学新著——评《证据学新论》

《证据学新论》是以证据运用为主要研究对象的新著。该书的贡献在于其出色的结构体系和理论的原创性、程序规则设置的科学性。其研究方法也颇具特色。

Evidence-based Clinical Chinese Medicine:What Has Changed Over the Past 20 Years

Chinese medicine has been used for centuries to treat a range of health conditions.This history has produced a wealth of classical literature,case studies and clinical research data detailing its use and effectiveness.However,high-quality and conclusive evidence that meets modern requirements for clinical decision support is lacking.This evidence gap limits the integration of Chinese medicine with contemporary medicine,which in turn limits global access and acceptance of Chinese medicine as a form of safe and effective health care.Over the past 20 years,researchers and organisations around the world,including the World Health Organization(WHO)and United Nations,have worked to support the integration of traditional medicines,such as Chinese medicine,with conventional medicines to improve global health care.This paper provides an overview of Chinese medicine studies published in the top four general medical journals(BMJ,JAMA,Lancet and New England Journal of Medicine)from February 2005 to February 2024 in the past 20 years to highlight the progress in the development of this evidence base.It also highlights key actions taken to promote evidence-based clinical Chinese medicine,including product and practitioner regulation,formalising education standards,and international collaborations.Research conducted at the China-Australia International Research Centre for Chinese Medicine demonstrates the benefits of such a collaboration.Through development of its unique and inclusive‘whole-evidence’approach,plus clinical studies and systematic reviews,the Centre has significantly contributed to the evidence base for clinical Chinese medicine.In addition,its high-impact papers and groundbreaking monographs have been cited in international conventional medicine guidelines.While progress has certainly been made during the past 20 years to build a stronger evidence base for clinical Chinese medicine,there is still a considerable gap that limits its integration with conventional medicine.Future funding and research are needed to continue this work and achieve to safe,effective and accessible traditional medicine as part of the WHO’s Universal Health Coverage strategy.

Temporal-Spatial Variances of Holocene Precipitation at the Marginal Area of the East Asian Monsoon Influences from Pollen Evidence

The woodland-steppe ecotone in the. southern Nei Mongol Plateau is located at the northern edge of the east Asian monsoon influences. A marked southeastern - northwestern (SE - NW) precipitation gradient exists in this region. Quantitative reconstruction of palaeo-precipitation of this region is helpful to reveal the development of monsoon climate and to predict die future desertification. Based on modern vegetation and surface pollen studies, a pollen-precipitation transfer function in the study region was established. Pollen data from three sediment sequences within the ecotone were used to reconstruct palaeo-precipitation during the Holocene. The processes of precipitation changes in the three sequences were quite different. There was a tendency of precipitation declined from the onset of the Holocene to 1 100 a BP in Haoluku. But, in Liuzhouwan and Xiaoniuchang, both located south of Haoluku, the annual precipitation reached highest values during 7 800 - 6 200 a BP and 7 200 - 5 000 a BP, respectively. The influences of southwestern (SW) monsoon and the variances of topographical conditions have possibly caused these temporal-spatial variances.

Review of salt consumption and stomach cancer risk:Epidemiological and biological evidence

Stomach cancer is still the fourth most common cancer;thus,it remains an important public health burden worldwide,especially in developing countries.The remarkable geographic variations in the rates of stomach cancer indicate that dietary factors,including a range of food groups to which salt and/or nitrates have been added,may affect stomach cancer risk.In this paper,we review the results from ecologic,case-control and cohort studies on the relationship between salt or salted foods and stomach cancer risk.The majority of ecological studies indicated that the average salt intake in each population was closely correlated with gastric cancer mortality.Most case-control studies showed similar results,indicating a moderate to high increase in risk for the highest level of salt or salted food consumption.The overall results from cohort studies are not totally consistent,but are suggestive of a moderate direct association.Since salt intake has been correlated with Helicobacter pylori(H pylori) infection,it is possible that these two factors may synergize to promote the development of stomach cancer.Additionally,salt may also cause stomach cancer through directly damaging gastric mucus,improving temporary epithelial proliferation and the incidence of endogenous mutations,and inducing hypergastrinemia that leads to eventual parietal cell loss and progression to gastric cancer.Based on the considerable evidence from ecological,case-control and cohort studies worldwide and the mechanistic plausibility,limitation on salt and salted food consumption is a practical strategy for preventing gastric cancer.

Covariation between personalities and individual differences in coping with stress:Converging evidence and hypotheses

In the past decade there has been a profusion of studies highlighting covariation between individual differences in stress physiology and behavioural profiles, here called personalities. Such individual differences in ways of coping with stress are relevant both in biomedicine, since different personalities may experience a different stress and disease vulnerability, and in behavioural ecology, since their adaptive value and evolutionary maintenance are the subject of debate. However, the precise way in which individual stress differences and personalities are linked is unclear. Here we provide an updated overview of this covariation across different species and taxa, consider its functional significance and present working hypotheses for how behavioural and physiological responses to stress might be causally linked, affecting life-history traits such as dispersal and life-span [Current Zoology 56 （6）： 728-740, 2010].

Is changing footstrike pattern beneficial to runners?

Some researchers, running instructors, and coaches have suggested that the "optimal" footstrike pattern to improve performance and reduce running injuries is to land using a mid-or forefoot strike. Thus, it has been recommended that runners who use a rearfoot strike would benefit by changing their footstrike although there is little scientific evidence for suggesting such a change. The rearfoot strike is clearly more prevalent. The major reasons often given for changing to a mid-or forefoot strike are(1) it is more economical;(2) there is a reduction in the impact peak and loading rate of the vertical component of the ground reaction force; and(3) there is a reduction in the risk of a running-related injuries. In this paper,we critique these 3 suggestions and provide alternate explanations that may provide contradictory evidence for altering one's footstrike pattern.We have concluded, based on examining the research literature, that changing to a mid-or forefoot strike does not improve running economy, does not eliminate an impact at the foot-ground contact, and does not reduce the risk of running-related injuries.

Common misconceptions about 5-aminosalicylates and thiopurines in inflammatory bowel disease

Misconceptions are common in the care of patients with inflammatory bowel disease(IBD).In this paper,we state the most commonly found misconceptions in clinical practice and deal with the use of 5-aminosalicylates and thiopurines,to review the related scientificevidence,and make appropriate recommendations.Prevention of errors needs knowledge to avoid making such errors through ignorance.However,the amount of knowledge is increasing so quickly that one new danger is an overabundance of information.IBD is a model of a very complex disease and our goal with this review is to summarize the key evidence for the most common daily clinical problems.With regard to the use of 5-aminosalicylates,the best practice may to be consider abandoning the use of these drugs in patients withsmall bowel Crohn's disease.The combined approach with oral plus topical 5-aminosalicylates should be the first-line therapy in patients with active ulcerative colitis;once-daily treatment should be offered as a first choice regimen due to its better compliance and higher efficacy.With regard to thiopurines,they seem to be as effective in ulcerative colitis as in Crohn's disease.Underdosing of thiopurines is a form of undertreatment.Thiopurines should probably be continued indefinitely because their withdrawal is associated with a high risk of relapse.Mercaptopurine is a safe alternative in patients with digestive intolerance or hepatotoxicity due to azathioprine.Finally,thiopurine methyltransferase(TPMT)screening cannot substitute for regular monitoring because the majority of cases of myelotoxicity are not TPMT-related.

Biology, staging, and treatment of breast cancer during pregnancy: reassessing the evidences

Breast cancer is one of the most frequently diagnosed malignancies during pregnancy. Here, we review the management of women with breast cancer during pregnancy(BCP), focusing on biology, diagnosis and staging, local and systemic treatments, obstetric care and long-term follow-up of children with prenatal exposure to anticancer treatments.

Aortic stenosis： insights on pathogenesis and clinical implications

Aortic stenosis （AS） is a common valvular heart disease in the Western populations, with an estimated overall prevalence of 3% in adults over 75 years. To understand its patho-biological processes represents a priority. In elderly patients, AS usually involves trileaflet valves and is referred to as degenerative calcific processes. Scientific evidence suggests the involvement of an active ＂atherosclerosis-like＂ pathogenesis in the initiation phase of degenerative AS. To the contrary, the progression could be driven by different forces （such as mechanical stress, genetic factors and interaction between inflammation and calcification）. The improved understanding presents potentially new therapeutic targets for preventing and inhibiting the development and progression of the disease. Furthermore, in clinical practice the management of AS patients implies the evaluation of generalized atherosclerotic manifestations （i.e., in the coronary and carotid arteries） even for prognostic reasons. In counselling elderly patients, the risk stratification should address individual frailty beyond the generic risk scores. In these regard, the co-morbidities, and in particular those linked to the global atherosclerotic burden, should be carefully investigated in order to define the risk/benefit ratio for invasive treatment strategies. We present a detailed overview of insights in pathogenesis of AS with possible practical implications.

An Evidence of Aerosol Indirect Effect on Stratus Clouds from the Integrated Ground-Based Measurements at the ARM Shouxian Site

The aerosol effect on clouds was explored using remote sensing of aerosol and cloud data at Shouxian, China. Non-precipitation, ice-free, and overcast clouds were firstly chosen by a combination of sky im- ages from the Total Sky Imager （TSI）, cloud base heights from the Ceilometer, and vertical temperature profiles from the Balloon-Borne Sounding System （BBSS）. Six cases were chosen in summer, and seven in autumn. The averaged cloud effective radii （re）, cloud optical depth （COD）, aerosol total light scattering coefficient （a）, and liquid water path （LWP） are, respectivey, 6.47 μm, 35.4, 595.9 mm-1, 0.19 mm in summer, and 6.07 μm, 96.0, 471.7 mm-1, 0.37 mm in autumn. The correlation coefficient between re and tc was found to change from negative to positive value as LWP increases.

Composition and Origin of Ferromanganese Crusts from Equatorial Western Pacific Seamounts

In the equatorial western Pacific, iron-manganese oxyhydroxide crusts(Fe-Mn crusts) and nodules form on basaltic seamounts and on the top of drowned carbonate platform guyots that have been swept free of pelagic sediments. To date, the Fe-Mn crusts have been considered to be almost exclusively of abiotic origin. However, it has recently been suggested that these crusts may be a result of biomineralization. Although the Fe-Mn crust textures in the equatorial western Pacific are similar to those constructed by bacteria and algae, and biomarkers also document the existence of bacteria and algae dispersed within the Fe-Mn crusts, the precipitation, accumulation and distribution of elements, such as Fe, Mn, Ni and Co in Fe-Mn crusts are not controlled by microbial activity. Bacteria and algae are only physically incorporated into the crusts when dead plankton settle on the ocean floor and are trapped on the crust surface. Geochemical evidence suggests a hydrogenous origin of Fe-Mn crusts in the equatorial western Pacific, thus verifying a process for Fe-Mn crusts that involves the precipitation of colloidal phases from seawater followed by extensive scavenging of dissolved trace metals into the mineral phase during crust formation.

The Moon

Recent geochemical and geophysical data from the Moon enable a revision of earlier interpretations regarding lunar origin, structure and bulk composition. Earth and Moon show many similarities among their isotopic compositions, but they have evolved in totally dissimilar ways, probably related to the deficiency of water and volatile elements in the Moon as well as the vast differences in size and internal pressure. Some global geochemical differences from the Earth such as volatile depletion based on K/U ratios have been established. However, all current lunar samples come from differentiated regions, making the establishment of a bulk composition more reliant on bulk geophysical properties or isotopic similarities; it remains unclear how the latter arose or relate to whole Moon composition. The lack of fractionation effects among the refractory and super-refractory elements indicates that the proto-lunar material seems unlikely to have been vaporized while the presence of volatile elements may place lower limits on proto-lunar temperatures. The apparent lack of geochemical evidence of an impacting body enables other possible impactors, such as comets, to be considered. Although the origin of the Moon remains currently unknown, it is generally believed that the Moon originated as the result of a giant impact on the Earth.

Commentary on:“Assessing proprioception:A critical review of methods”by Han et al.

In recent years,the assessment of proprioceptive function has received increased attention in clinical and motor skill research.This is not surprising given the growing body of scientific evidence on the importance of proprioceptive information for controlling nearly all facets of human movement;from standing to performing highly skilled movement patterns

Does Time Studying of Spanish Make Learners More Cognizant of Their Learning Styles？ Evidence From Novice and Senior L2 Spanish Learners

This study explored the perceptual learning style preferences in L2 （second language） Spanish. A group of first-semester and fifth-semester university students participated. The aim was to verify whether time studying of Spanish would strengthen learning preferences making senior students more cognizant of their preferred styles. Senior students were, therefore, more expected to self-report major （i.e., strong） style preferences than novice students. The participants completed a style questionnaire and named preferred in-class language activities. Results showed that the novice rather than the senior students, self-reported strong style preferences. The senior students consistently reported minor preferences and named activities that favored peer collaboration over perceptual styles. It is likely that after several semesters of learning Spanish, senior students were less certain as to whether language learning relies on strong style preferences. Instead, they probably learned to acknowledge the benefits of a flexible disposition, integrating several minor style preferences for a successful learning of Spanish.

Monitoring open water area changes in a small tarn using historical orthophotomaps and a historical bathymetric map:a case study of the Litworowy Staw lake,the High Tatras

According to scientific evidence in general, the disappearance of the Tatras tarns as a result of external geomorphological processes has been accepted since the long term analyses of lake sediments and peat bogs, geomorphological mapping, geophysical measurements(– all indirect methods). It is paradoxical that the direct cartographic evidence of such changes has not existed until now. In this paper, we evaluate shore line changes of the small mountain glacial lake in the High Tatras-Litworowy Staw lake using a multitemporal analysis of a series of historical orthophotomaps and a historical map. Over the last 100 years, the tarn has lost 46.4% of open water level area. Significant visual changes were caused by vegetation growth of Carex species(sedges) on the water's surface. The accumulation of fine sediments and dead plant residues in the tarn basin create suitable conditions for this process, all together causing the tarn to become more shallow.

Graphic Organizers and Reading Comprehension Ability： Evidence From Iranian EFL University Students

The present study investigated the impact from GOs （Graphic Organizers） upon reading comprehension ability. To this end, an OPT （Oxford Placement Test） was administered to a research population （N = 354） in order to homogenize it. On the basis of the test results, the population was sorted into three groups of reading-low, reading-mid, and reading-high students. Sixty participants with the lowest level of reading comprehension proficiency were randomly selected and assigned to an EG （Experimental Group） （N = 30） and a CG （Control Group） （N = 30）. Afterwards, a TOEFL （Test of English as a Foreign Language） reading comprehension pretest was administered to both groups in order to determine their current level of reading proficiency. Then, the EG received 10 successive 90-minute sessions on GOs as post-reading strategies for expository text comprehension, while the CG received the same amount of treatment on other post-reading strategies. In the end, another TOEFL reading comprehension posttest was administered to the research groups to measure their reading comprehension performance level after the treatment. The results revealed that GOs were statistically more significant and effective for the low-skilled readers than other post-reading strategies.

The Modals as Pragmatic Softening Devices： Evidence From Late Modern English Grammar and Manner Books

In this research, the author considers the evidence provided by a corpus of Late Modem English grammars for our understanding of the development of the modals as politeness markers. It is possible to see how the modals and their accompanied senses are explained in an official （and often either prescriptive or proscriptive） perspective. This is another aspect which cannot be ascertained from the usage based on corpora which seem to be popular as sources of evidence in historical pragmatics. In this sense, this research brings some novel perspective to this aspect of academic study. It is possible to notice that the significations involves concept or senses which extend across a semantic--pragmatic domain which includes politeness. We can see that certain softening senses are key elements to mark polite usage. The main data used come from the descriptions of the modal auxiliary verb in a corpus of grammar books from the period. Usage and manner books are also consulted as a secondary resource. The manner book in particular is quite helpful for our understanding of how linguistic politeness was regarded at the time. Such texts also help us to find a certain network of senses which are related to polite expressions.

Endoscopic findings in patients with Schatzki rings:Evidence for an association with eosinophilic esophagitis

AIM:To investigate endoscopic findings in patients with Schatzki rings(SRs) with a focus on evidence for eosinophilic esophagitis(EoE).METHODS:We consecutively approached all adult patients scheduled for elective outpatient upper endoscopy for a variety of indications at the German Diagnostic Clinic,Wiesbaden,Germany between July 2007 and July 2010.All patients with endoscopically diagnosed SRs,defined as thin,symmetrical,mucosal structures located at the esophagogastric junction,were prospectively registered.Additional endoscopic findings,clinical information and histopathological findings with a focus on esophageal eosinophilia(≥ 20 eosinophils/high power field) were recorded.The criteria for active EoE were defined as:(1) eosinophilic tissue infiltration ≥ 20 eosinophils/hpf;(2) symptoms of esophageal dysfunction;and(3) exclusion of other causes of esophageal eosinophilia.Gastroesophageal reflux disease was excluded by proton pump inhibitor treatment prior to endoscopy.The presence of ≥ 20 eosinophils/hpf in esophageal biopsies in patients that did not fulfil the criteria of EoE was defined as esophageal hypereosinophilia.RESULTS:A SR was diagnosed in 171(3.3%;128 males,43 females,mean age 66 ± 12.9 years) of the 5163 patients that underwent upper gastrointestinalendoscopy.Twenty of the 116 patients(17%) from whom esophageal biopsies were obtained showed histological hypereosinophilia(≥ 20 eosinophils/hpf).Nine of these patients(8 males,1 female,mean age 49 ± 10 years) did not fulfill all diagnostic criteria of EoE,whereas in 11(9%) patients with ≥ 20 eosinophils/hpf,a definite diagnosis of EoE was made.Three of the 11 patients(27%) with definite EoE had no suspicious endoscopic features of EoE.In contrast,in the 25 patients in whom EoE was suspected by endoscopic features,EoE was only confirmed in 7(28%) patients.Patients with EoE were younger(mean age 41.5 ± 6.5 vs 50.5 ± 11.5 years,P = 0.012),were more likely to have a history of allergies(73% vs 29%,P = 0.007) and complained more often of dysphagia(91% vs 34%,P = 0.004) and food impaction(36% vs 6%,P = 0.007) than patients without EoE.Endoscopically,additional webs were found significantly more often in patients with EoE than in patients without EoE(36% vs 11%,P = 0.04).Furthermore,the SR had a tendency to be narrower in patients with EoE than in those without EoE(36% vs 18%,P = 0.22).The percentage of males(73% vs 72%,P = 1.0) and frequency of heartburn(27% vs 27%,P = 1.0) were not significantly different in both groups.The 9 patients with esophageal hypereosinophilia that did not fulfil the diagnostic criteria of EoE were younger(mean age 49 ± 10 years vs 58 ± 6 years,P = 0.0008) and were more likely to have a history of allergies(78% vs 24%,P = 0.003) than patients with < 20 eosinophils/hpf.Predictors of EoE were younger age,presence of dysphagia or food impaction and a history of allergies.CONCLUSION:A significant proportion of patients with SRs also have EoE,which may not always be suspected according to other endoscopic features.

Calculation and Verification for the Thermodynamic Data of 3CaO·3Al_2O_3·CaSO_4

Calcium sulfoaluminate,3CaO·3Al2O3·CaSO4,has been widely recognized in the realms of high-temperature combustion and cement chemistry.However,the lack of relevant thermodynamic data limits the progress of its research and development.Through comparative calculations using several different approaches,we obtain the thermochemical properties of 3CaO·3Al2O3·CaSO4 in this work,such as its standard formation enthalpy,Gibbs free en- ergy of formation,entropy,and molar heat capacity.With these fundamental data,thermodynamic calculations become possible for reactions involving this mineral.It is found that some reactions proposed in literature to generate this mineral may not proceed thermodynamically.