AIM:To evaluate the impact of surgical volume on nationwide hospital mortality after pancreaticoduodenectomy(PD) for periampullary tumors in South Korea.METHODS:Periampullary cancer patients who underwent PD between 2...AIM:To evaluate the impact of surgical volume on nationwide hospital mortality after pancreaticoduodenectomy(PD) for periampullary tumors in South Korea.METHODS:Periampullary cancer patients who underwent PD between 2005 and 2008 were analyzed from the database of the Health Insurance Review and Assessment Service of South Korea.A total of 126 hospitals were divided into 5 categories,each similar in terms of surgical volume for each category.We used hospital mortality as a quality indicator,which was defined as death during the hospital stay for PD,and calculated adjusted mortality through multivariate logistic models using several confounder variables.RESULTS:A total of eligible 4975 patients were enrolled in this study.Average annual surgical volume of hospitals was markedly varied,ranging from 215 PDs in the very-high-volume hospital to < 10 PDs in the verylow-volume hospitals.Admission route,type of medical security,and type of operation were significantly different by surgical volume.The overall hospital mortality was 2.1% and the observed hospital mortality by surgical volume showed statistical difference.Surgical volume,age,and type of operation were independent risk factors for hospital death,and adjusted hospital mortality showed a similar difference between hospitals with observed mortality.The result of the HosmerLemeshow test was 5.76(P = 0.674),indicating an acceptable appropriateness of our regression model.CONCLUSION:The higher-volume hospitals showed lower hospital mortality than the lower-volume hospitals after PD in South Korea,which were clarified through the nationwide database.展开更多
The active-fault-alarm （AFA） technologies and the dynamic protection mechanism of the optical network controlled by the multi-protocol label switching transport profile （MPLS-TP） are both studied in this article. ...The active-fault-alarm （AFA） technologies and the dynamic protection mechanism of the optical network controlled by the multi-protocol label switching transport profile （MPLS-TP） are both studied in this article. On this basis, an active dynamic pre-protection （ADPP） mechanism is proposed. This active dynamic pre-protection mechanism is allowed to establish a so called temporary protection path （TPP） for the work path before a potential fault occurs and to switch to TPP only after the fault occurs. It keeps the TPP flexibly only when it is in low- quality or fault state to realize dynamic protection even better and to achieve better resource utilization. Simulation results show that the proposed new mechanism has better performance in terms of the flexibility and the efficiency from the perspective of time.展开更多
Military talents are those who have higher culture and scientific quality, much strong innovation consciousness and thinking ability. The overall objective of military talent training is to cultivate the comprehensive...Military talents are those who have higher culture and scientific quality, much strong innovation consciousness and thinking ability. The overall objective of military talent training is to cultivate the comprehensive-quality military personnel that meet the requirements of military modernization and preparations for military struggle. In this paper, we construct the military talent training objectives model, and on this basis, we propose the innovative military talent training mode, from the perspective of curriculum content system and talent quality assurance system.展开更多
文摘AIM:To evaluate the impact of surgical volume on nationwide hospital mortality after pancreaticoduodenectomy(PD) for periampullary tumors in South Korea.METHODS:Periampullary cancer patients who underwent PD between 2005 and 2008 were analyzed from the database of the Health Insurance Review and Assessment Service of South Korea.A total of 126 hospitals were divided into 5 categories,each similar in terms of surgical volume for each category.We used hospital mortality as a quality indicator,which was defined as death during the hospital stay for PD,and calculated adjusted mortality through multivariate logistic models using several confounder variables.RESULTS:A total of eligible 4975 patients were enrolled in this study.Average annual surgical volume of hospitals was markedly varied,ranging from 215 PDs in the very-high-volume hospital to < 10 PDs in the verylow-volume hospitals.Admission route,type of medical security,and type of operation were significantly different by surgical volume.The overall hospital mortality was 2.1% and the observed hospital mortality by surgical volume showed statistical difference.Surgical volume,age,and type of operation were independent risk factors for hospital death,and adjusted hospital mortality showed a similar difference between hospitals with observed mortality.The result of the HosmerLemeshow test was 5.76(P = 0.674),indicating an acceptable appropriateness of our regression model.CONCLUSION:The higher-volume hospitals showed lower hospital mortality than the lower-volume hospitals after PD in South Korea,which were clarified through the nationwide database.
基金Supported by the National High Technology Research and Development Program of China（No. 2009AA01Z255, 2009AA01A345）, the National Basic Research Program of China（No. 2007CB310705 ） and the National Natural Science Foundation of China（No. 60932004）.
文摘The active-fault-alarm （AFA） technologies and the dynamic protection mechanism of the optical network controlled by the multi-protocol label switching transport profile （MPLS-TP） are both studied in this article. On this basis, an active dynamic pre-protection （ADPP） mechanism is proposed. This active dynamic pre-protection mechanism is allowed to establish a so called temporary protection path （TPP） for the work path before a potential fault occurs and to switch to TPP only after the fault occurs. It keeps the TPP flexibly only when it is in low- quality or fault state to realize dynamic protection even better and to achieve better resource utilization. Simulation results show that the proposed new mechanism has better performance in terms of the flexibility and the efficiency from the perspective of time.
文摘Military talents are those who have higher culture and scientific quality, much strong innovation consciousness and thinking ability. The overall objective of military talent training is to cultivate the comprehensive-quality military personnel that meet the requirements of military modernization and preparations for military struggle. In this paper, we construct the military talent training objectives model, and on this basis, we propose the innovative military talent training mode, from the perspective of curriculum content system and talent quality assurance system.
