内评估在卫生防病机构管理中的作用及其实施

1评估及评估的分类 评估是指从目标或特殊目的角度来评价一项活动,评估的目的就是要说明一项活动是否已经成功,或者在什么程度上没能达到预定目标;或指通过与某一适当标准的比较来评价一项活动.

多层螺旋CT对主动脉-左室通道的虚拟管腔内评估

主动脉-左室通道（ALVT）是指起源于右冠状动脉窦，经右室流出道入主动脉瓣下左心室的一种罕见的异常通道。如同在虚拟结肠镜检查中的应用一样，多层螺旋CT的独特性能在心血管疾病患者中得以确证。本文在此探讨1例ALVT患者中的虚拟管腔内成像。该例18岁的男性患者因长达6个月的进行性劳力性呼吸困难入院。患者在5个月大时即被诊断患有ALVT，并通过人工补片封堵了通道的主动脉口，仅残留有轻微的主动脉反流。此次住院时，体格检查在胸骨右上缘可闻及3／6级舒张期杂音。16层螺旋CT血管造影检查证实ALVT。

Assessment of the validity of the clinical pathway for colon endoscopic submucosal dissection

AIM: To determine the effective hospitalization period as the clinical pathway to prepare patients for endoscopic submucosal dissection (ESD). METHODS: This is a retrospective observational study which included 189 patients consecutively treated by ESD at the National Cancer Center Hospital from May 2007 to March 2009. Patients were divided into 2 groups; patients in group A were discharged in 5 d and patients in group B included those who stayed longer than 5 d. The following data were collected for both groups: mean hospitalization period, tumor site, median tumor size, post-ESD rectal bleeding requiring urgent endoscopy, perforation during or after ESD, abdominal pain, fever above 38 ℃, and blood test results positive for inflammatory markers before and after ESD. Each parameter was compared after data collection. RESULTS: A total of 83% (156/189) of all patients could be discharged from the hospital on day 3 postESD. Complications were observed in 12.1% (23/189) of patients. Perforation occurred in 3.7% (7/189) of patients. All the perforations occurred during the ESD procedure and they were managed with endoscopic clipping. The incidence of post-operative bleeding was 2.6% (5/189); all the cases involved rectal bleeding. We divided the subjects into 2 groups: tumor diameter ≥ 4 cm and < 4 cm; there was no significant difference between the 2 groups (P = 0.93, χ 2 test with Yates correction). The incidence of abdominal pain was 3.7% (7/189). All the cases occurred on the day of the procedure or the next day. The median white blood cell count was 6800 ± 2280 (cells/μL; ± SD) for group A, and 7700 ± 2775 (cells/μL; ± SD) for group B, showing a statistically significant difference (P = 0.023, t-test). The mean C-reactive protein values the day after ESD were 0.4 ± 1.3 mg/dL and 0.5 ± 1.3 mg/dL for groups A and B, respectively, with no significant difference between the 2 groups (P = 0.54, t -test). CONCLUSION: One-day admission is sufficient in the absence of complications during ESD or early postoperative bleeding.

Fraud Prevention Mechanisms of Malaysian Government-Linked Companies： An Assessment of Existence and Effectiveness

Understanding the root causes of fraud and learning about the most effective fraud prevention mechanisms are critical in reducing the incidence of financial fraud. Therefore, this study solicits the views of fraud investigators on the existence and effectiveness of fraud prevention mechanisms within Government-Linked Companies （GLCs）. Specifically, effective fraud prevention mechanisms （FPM） should be undertaken by five critical groups, namely the board of directors, audit committees, external auditors, internal auditors, and anti-fraud specialists. A total of 147 questionnaires were distributed to fraud investigators of all public listed GLCs in Malaysia. Out of those, a total of 45 usable responses were received, which represents an effective response rate of 30.6%. In terms of existence, the respondents ranked ＂management review of internal controls＂ and ＂external audits of financial statements＂ as the top-most FPMs. This was followed by other mechanisms such as operational audits, internal audits and internal control review/improvements by departments. Out of the 27 fraud prevention mechanisms, fraud investigators perceiyed surprise audits, fraud hotline, fraud prevention program and training, anti-fraud policy, fraud vulnerability reviews, operational audits, whistle-blowing policy, internal audit or fraud examination department, and, imposing penalty and disciplinary action as more effective than the others. Overall, this study provides important insights to practitioners and organizations in identifying fraud prevention mechanisms that are most effective.

Gaussia Luciferase Reporter Assay for Assessment of Gene Delivery Systems in Vivo

Objective To develop an alternative method for assessment of gene delivery systems in vivo.Methods Mouse primary spleen lymphocytes were genetically modified in vitro by a retroviral vector harboring a Gaussia luciferase(Gluc) expression cassette.After implantation of these cells into recipient mice,the expression of Gluc was detected in whole blood or plasma collected.Results As little as 10 μL whole blood drawn from the recipient mice could guarantee prompt reading of Gluc activity with a luminometer.And the reading was found in good correlation with the number of genetically modified spleen lymphocytes implanted to the mice.Conclusions Gluc may be useful as an in vivo reporter for gene therapy researches,and Gluc blood assay could provide an alternative method for assessment of gene delivery systems in vivo.

In Vivo Anti-Inflammatory Assessment of Quillaja saponaria Mol. Extracts

Aqueous extracts from the native Chilean Quillaja saponaria tree are used orally and topically to treat lung inflammatory problems and toothache. This study aimed to corroborate their presumed anti-inflammatory activity, identify their active ingredients and validate their use. The topical anti-inflammatory activity of a commercial partially purified Quillaja saponin aqueous extract （Ultra Dry 100Q, UD）, the crude acid hydrolysate （H-100Q） of this material, its two most abundant sapogenins QA （quillaic acid） and PA （phytolaccagenic acid）, and two formulations containing QA were subjected to topical assays for the inhibition ofmurine ear inflammation elicited by AA （arachidonic acid） or TPA （phorbol ester）. The dose-dependent anti-inflammatory activity of QA was confirmed in both AA （maximal effect 92.1%） and TPA （maximal effect 62.2%） assays, and PA showed significant anti-inflammatory activity against AA （46.5%）. Two dermo pharmaceutical formulations containing 8% w/v QA as the active ingredient--a cream and a gel--also exhibited significant anti-inflammatory effects in the TPA （50.8%） and AA （39.5%） assays.

A decision hyper plane heuristic based artificial immune network classification algorithm

Most of the developed immune based classifiers generate antibodies randomly, which has negative effect on the classification performance. In order to guide the antibody generation effectively, a decision hyper plane heuristic based artificial immune network classification algorithm （DHPA1NC） is proposed. DHPAINC taboos the inner regions of the class domain, thus, the antibody generation is limited near the class domain boundary. Then, the antibodies are evaluated by their recognition abilities, and the antibodies of low recognition abilities are removed to avoid over-fitting. Finally, the high quality antibodies tend to be stable in the immune network. The algorithm was applied to two simulated datasets classification, and the results show that the decision hyper planes determined by the antibodies fit the class domain boundaries well. Moreover, the algorithm was applied to UCI datasets classification and emotional speech recognition, and the results show that the algorithm has good performance, which means that DHPAINC is a promising classifier.

Stress-induced visceral analgesia assessed non-invasively in rats is enhanced by prebiotic diet

AIM: To investigate the influence of repeated water avoidance stress (rWAS) on the visceromotor response (VMR) to colorectal distension (CRD) and the modulation of the response by a prebiotic diet in rats using a novel surgery-free method of solid-state manometry.METHODS: Male Wistar rats fed a standard diet with or without 4% enzyme-treated rice fiber (ERF) for 5 wk were subjected to rWAS (1 h daily x 10 d) or no stress. The VMR to graded phasic CRD was assessed by intraluminal colonic pressure recording on days 0 (base-line), 1 and 10 (45 min) and 11 (24 h) after rWAS and expressed as percentage change from baseline. Cecal content of short chain fatty acids and distal colonic histology were assessed on day 11. RESULTS: WAS on day 1 reduced the VMR to CRD at 40 and 60 mmHg similarly by 28.9% ± 6.6% in both diet groups. On day 10, rWAS-induced reduction of VMR occurred only at 40 mmHg in the standard diet group (36.2% ± 17.8%) while in the ERF group VMR was lowered at 20, 40 and 60 mmHg by 64.9% ± 20.9%, 49.3% ± 11.6% and 38.9% ± 7.3% respectively. The visceral analgesia was still observed on day 11 in ERF-but not in standard diet-fed rats. By contrast the non-stressed groups (standard or ERF diet) exhibited no changes in VMR to CRD. In standard diet-fed rats, rWAS induced mild colonic histological changes that were absent in ERF-fed rats exposed to stress compared to non-stressed rats. The reduction of cecal content of isobutyrate and total butyrate, but not butyrate alone, was correlated with lower visceral pain response. Additionally, ERF diet increased rWAS-induced defecation by 26% and 75% during the first 0-15 min and last 15-60 min, respectively, compared to standard diet, and reduced rats' body weight gain by 1.3 fold independently of their stress status. CONCLUSION: These data provide the first evidence of psychological stress-related visceral analgesia in rats that was enhanced by chronic intake of ERF prebiotic.

Magnifying endoscopy in upper gastroenterology for assessing lesions before completing endoscopic removal

Any prognosis of gastrointestinal (GI) cancer is closely related to the stage of the disease at diagnosis.Endoscopic submucosal dissection (ESD) and en bloc endoscopic mucosal resection (EMR) have been performed as curative treatments for many early-stage GI lesions in recent years.The technologies have been widely accepted in many Asian countries because they are minimally invasive and supply thorough histopathologic evaluation of the specimens.However,before engaging in endoscopic therapy,an accurate diagnosis is a precondition to effecting the complete cure of the underlying malignancy or carcinoma in situ.For the past few years,many new types of endoscopic techniques,including magnifying endoscopy with narrow-band imaging (MENBI),have emerged in many countries because these methods provide a strong indication of early lesions and are very useful in determining treatment options before ESD or EMR.However,to date,there is no comparable classification equivalent to "Kudo's Pit Pattern Classification in the colon",for the upper GI,there is still no clear internationally accepted classification system of magnifying endoscopy.Therefore,in order to help unify some viewpoints,here we will review the defining optical imaging characteristics and the current representative classifications of microvascular and microsurface patterns in the upper GI tract under ME-NBI,describe the accurate relationship between them and the pathological diagnosis,and their clinical applications prior to ESD or en bloc EMR.We will also discuss assessing the differentiation and depth of invasion,defying the lateral spread of involvement and targeting biopsy in real time.

Correlations between endoscopic and clinical disease activity indices in intestinal Behcet's disease

AIM:To develop a novel endoscopic severity model of intestinal Behcet's disease(BD) and to evaluate its feasibility by comparing it with the actual disease activity index for intestinal Behcet's disease(DAIBD).METHODS:We reviewed the medical records of 167 intestinal BD patients between March 1986 and April 2011.We also investigated the endoscopic parameters including ulcer locations,distribution,number,depth,shape,size and margin to identify independent factors associated with DAIBD.An endoscopic severity model was developed using significant colonoscopic variables identified by multivariate regression analysis and its correlation with the DAIBD was evaluated.To determine factors related to the discrepancy between endoscopic severity and clinical activity,clinical characteristics and laboratory markers of the patients were analyzed.RESULTS:A multivariate regression analysis revealed that the number of intestinal ulcers(≥ 2,P = 0.031) and volcanoshaped ulcers(P = 0.001) were predictive factors for the DAIBD.An endoscopic severity model(Y) was developed based on selected endoscopic variables as follows:Y = 47.44 + 9.04 × non-Ileocecal area + 11.85 ×≥ 2 of intestinal ulcers + 5.03 × shallow ulcers + 12.76 × deep ulcers + 4.47 × geographicshaped ulcers + 26.93 × volcano-shaped ulcers + 8.65 ×≥ 20 mm of intestinal ulcers.However,endoscopic parameters used in the multivariate analysis explained only 18.9% of the DAIBD variance.Patients with severe DAIBD scores but with moderately predicted disease activity by the endoscopic severity model had more symptoms of irritable bowel syndrome(21.4% vs 4.9%,P = 0.026) and a lower rate of corticosteroid use(50.0% vs 75.6%,P = 0.016) than those with severe DAIBD scores and accurately predicted disease by the model.CONCLUSION:Our study showed that the number of intestinal ulcers and volcano-shaped ulcers were predictive factors for severe DAIBD scores.However,the correlation between endoscopic severity and DAIBD(r = 0.434) was weak.

Assessment of participant satisfaction with upper gastrointestinal endoscopy in South Korea

AIM:To measure the perceived satisfaction with gastric cancer screening as part of the National Cancer Screening Program (NCSP) in South Korea.METHODS:Data were derived from the participantsin a satisfaction survey of the Quality Evaluation of National Cancer Screening in 2009.This is a populationbased nationwide telephone survey of participants who were screened by the NCSP between May and October 2009.This study included 4412 participants who provided full sets of data and who had upper endoscopies for the purpose of gastric cancer screening.RESULTS:The negative appraisal percentages for each of the seven questions were as follows:explanation in preparation for the upper endoscopy,12.3%;explanation about the process and procedure of the upper endoscopy,13.8%;explanation about any pain or discomfort related to the upper endoscopy,27.5%;level of pain during the procedure,30.3%;physical environment,16.2%;manner of the staff,11.2%,and privacy protection,8.8%.CONCLUSION:The critical issues identified by the Pareto analysis include the adequacy of the explanation about any pain or discomfort associated with the upper endoscopy and the level of pain experienced during the procedure.

EVA based model to estimate the Chinese listed company’s intrinsic value

This article is based on traditionally intrinsic value assessment model. We employed the assumption on the differences in future increase rates of companies, taking into account of the expected Economic Value Added (EVA) discount and the capital investment, to establish a high increase model, a two-stage EVA discount model and a three-stage EVA discount model for the intrinsic value assessment. Those models eliminate the great fluctuation of free cash flow in calculating the capital expenditure by setting aside the cash flow of the company’s investment in the year and considering only the capital cost. This method needs only to assess the EVA flow in different year in probing the intrinsic value of a company, thus give more consistent conclusion than conventional methods.

Molecular diversity of Enteromorpha from the coast of Yantai:a dual-marker assessment

We collected nine Enteromorpha specimens from the coast of Yantai and evaluated their diversity based on analyses of their ITS(internal transcribed spacer) and 5S rDNA NTS(non-transcribed spacer) sequences.The ITS sequences showed slight nucleotide divergences between Enteromorpha linza and Enteromorpha prolifera.In contrast,multiple highly variable regions were found in the ITS region of Enteromorpha flexuosa.In general,there were more variable sites in the NTS region than in the ITS region in the three species.The variations in 5S rDNA NTS sequences indicated that the molecular diversity of Enteromorpha from the coast of Yantai is very high.However,a phylogenetic tree constructed using 5S rDNA NTS sequence data indicated that genetic differences were not directly related to geographical distribution.

Research Progress of Migration and Transformation of Pharmaceuticals and Personal Care Products in Underground Environment

With the increasing use of PPCPs （pharmaceuticals and personal care products）, the impact caused by the accumulation of PPCPs on the environment has become increasingly serious and has attracted considerable attention. In the last 10 years, major studies on PPCPs have focused on the sources and analytical testing of concentrations in the environment. Afterward, studies have shifted to the transfer and transformation of PCPPs in the environment and to the environmental risk assessment of PPCPs. Studies on PPCPs in the underground environment have mainly focused on their adsorption, desorption, transfer, and transformation in the aeration and saturation zones. The main methods applied in these studies include indoor simulation experiments and outdoor sampling and testing. These studies have mainly considered one dimension, and most of them have concentrated only on the aeration or saturation zone. Therefore, the main developing directions of studies on PPCPs are the comprehensive study of the transfer and transform process from source to sink in the underground environment and the establishment of an effective and efficient PPCP detection system,

Reviewing Design References with Diagrams： A Metropolitan Performance Assessment Perspective

The announcement of major sporting events scheduled to take place in Rio de Janeiro in the coming years is now producing several radical urban transformations that are attracting the attention of renowned architects of the international circuit. All this is happening in a city where relevant architectural references have not been produced for a long while because of the prolonged economic crisis of the past. Despite these conditions, people were able to detect “invisible” design lessons to be learned in this city by sharing perceptual experiences with foreign observers who are, by definition, unaware of their preconceptions. This paper deals with the development of a strategy for re-presenting design references that are locally rooted and accessible for direct embodied experience. The strategy put forward a MPI （metropolitan performance index） drawn out from a bibliographical survey coupled with analytical spatial diagrams of different case-studies presented as a tour guide for the recognition of the architecture produced in Rio de Janeiro. It is believed that this strategy can favor the adoption of an eye attuned to contemporary theories especially interested in the spatial and programmatic concerns that today instigate the designer.

Recent Progress of Diffusion Weighted Magnetic Resonance Imaging in Assessment of Tumor in the Body

In the last couple of years,as the development ofnew imaging techniques,diffusion-weighted magnetic resonanceimaging (DW-MRI) has been applied increasingly in the evaluationof various diseases in the body,and has been adopted frequentlyas an imaging tool in clinical tumor assessment.As a completelynon-invasive,highly sensitive,well-tolerated and relatively lowcost technique,diffusion-weighted imaging (DWI) can supplyboth quantitative and qualitative information at the cellular levelby exploring irregular diffusion motion of water molecules withintissues in the body.In this article,we summarized the recentapplication and reliability of DWI in tumor evaluation includingtumor detection,tumor features,and outcome of early treatmentresponse.

Economic Viability of Production of Tree Parica （Schizolobium amazonicum Huber ex. Ducke） of Reforestation Project in the Municipality Paragominas-PA, Brazil

The objective of this study was to analyze the profitability of production Parica reforestation in the municipality of Paragominas-PA. The study was conducted in the municipality of Paragominas Messoregiao located in the northeast of Para. The basic data used in the economic evaluation of production of planting parica （costs and revenues） were derived from primary source through raising production cost of parica with farmers from the municipality, analyzing the period of production horizon of seven years. The discount rate chosen for economic evaluation was 10% per year. NPV （net present value） calculation IRR （internal rate of return）, BCR （benefit-cost ratio） and EP （break-even point）. To check the economic feasibility of producing parica the following criteria were used for economic analysis. The results for NPV, IRR and BC ratio were respectively of $495,970, 28.83% and 2.43. For EP （break-even point） the value of 41.08% was found, which demonstrates the minimum amount of production, so that revenue equals costs. Based on the results obtained, it was found that the reforestation model with parica proposed in this paper presents economically viable for deployment.

Analysis and Assessment of Agrimonia Pilosa Ledeb from Different Sources Using FT-IR Spectroscopy

To get the IR spectrums of Agrimonia Pilosa Ledeb （APL） from China and Japan areas, and to fend out the characters of IR spectrums through the content of different chemical constituents, to provide a fast and effective analysis method monitor the inherent qualities of traditional Chinese medicine-APL. Fourier Transform Infrared Spectroscopy （FT-IR） was applied to detect sample of APL from Ofina and Japan areas. This study showed that the IR spectra of APL from China and Japan areas have their unique IR fingerprint features. The contents of tannin and calcitum phosphate in APL from China is different APL from Japan. So FF-IR is a very quick, effective and well repetitive method for monitoring and distinguishing the traditional Chinese medicine.

The Challenges of Assessing the Output of EmergentEconomies： The Case of Bahrain

Business analysts worldwide use the standard theories and tools of macroeconomics and finance to determine the investment, trade or production possibilities in foreign markets. These evaluations are generally supported by three sources： estimations of using country-specific macroeconomic data on which they can determine patterns of growth, inflation, unemployment, productivity, income per capita, etc.; timely data on current conditions and developments in production, income and spending; and institutional information on policy makers, business practices and financial markets. This paper focuses on the first two where we examine the publically available macroeconomic data for the Kingdom of Bahrain to determine their reliability. Among our findings are： （1） creating a reliable data base of macroeconomic data is difficult due to data revision and incomplete data gathering; （2） the movement of standard macro-variables is often unusual, leading one to question further the reliability of the data; （3） based on available data it appears that the growth in Bahrain has been driven almost solely by an increase in the number of people working, with little to no apparent rise in productivity; and （4） the growth of GDP will eventually be constrained by physical limits on population growth, and can be improved only if ways can be found to increase the productivity of the workforce.

The Research On The Control Self- Assessment-Base On The Assessment Report

Internal control self-assessment is an internal control audit method which consists of the auditors＇ audit and entity managers together constitute an evaluation team. then result in a report of CSA which include the defects finding and improvement plan. As the product of it. research on the CSA report is very important. In this research base on the real data to study, and analysis shows that the quality of report in Chinese CSA were not high.