试论患者趋高就医的基层化

"倒三角形"的卫生资源配置引致了社区卫生机构医疗卫生服务质量的低下,这导致了患者对基层医疗卫生服务的不信任,因此患者到大医院趋高就医就成了常态。本研究建议大医院当顺势而为,实施良性扩张的发展战略,与社区卫生机构对接成"利益联合体",引导患者趋高就医的基层化。

中部地区县域居民就诊趋高现状调查

目的了解我国中部地区县域居民在不同症状与疾病下的医疗机构选择及趋高情况,探讨其影响因素,为引导居民合理就医提供依据。方法采用分层随机抽样的方法,选取安徽定远、河南息县、湖北黄石3地共784名居民以面对面的方式进行问卷调查。结果趋高居民占比达80.87%;居民总体趋高值的均数为5.36,趋高率为50.10%;疾病趋高值比症状趋高值高,两者呈正相关关系(R=0.641,P<0.001);住院患者、青年人(18~39岁)、本科及以上的居民,未婚居民,离县级医疗机构较近的居民趋高值显著高于同组其他居民(P<0.05);居民类型、年龄、教育程度、医疗机构距离差是居民就诊趋高的影响因素,其中教育程度影响最大(β=1.193)。结论当前居民就诊趋高明显,但极端情况较少;居民在明确疾病时就诊较仅有症状时更易趋高,且疾病趋高认知与症状一致;不同类型患者趋高程度各异,其中居民类型、年龄、教育程度、医疗机构距离差为主要影响因素。

乐队演奏中的音调趋高倾向

乐队在演奏过程中,其音调有一种趋高倾向.这种倾向的形成,有演奏力度、心理因素、温度变化以及演奏技法等多方面的原因.音调趋高倾向并不是什么坏事,但必须将它控制在微观层次之中才能起到好的作用,而不能让它扩展到宏观中去.

清代至民国时期民间借贷利率研究——以闽西培田为例

清代民国时期,闽西培田民间借贷领域形成了货币借贷利率与粮食借贷利率互相参照,流行利率与互助利率互相补充的利率体系。因为粮价的周期性波动,借贷兼营户被迫将回收的粮食本息推迟半年左右的时间出售,保存期间增加的成本实际由借贷人承担,粮食借贷在参照货币借贷利率的基础上,要再追加20个左右百分点。培田粮食借贷利率因而趋高。

Trends in extreme high temperature at different altitudes of Southwest China during 1961–2014

This study analyzed the trends in extreme high temperature in Southwest China based on the observed daily maximum temperature and average temperature data from 410 Chinese stations recently released by the China Meteorological Administration.The authors found that the trends in extreme high temperature at different altitudes of Southwest China exhibit staged variations during a recent 50-year period(1961–2014).The trends in mean temperature and maximum temperature also exhibit phase variation.All temperature-related variables increase gently during the period 1975–94,whereas they increase dramatically during the recent period of 1995–2014,with a rate that is approximately two to ten times more than that during 1975–94.In addition,the trends in mean temperature,maximum temperature,and the frequency of extreme high temperature in the low altitudes transit from negative to positive in the two periods,while they increase dramatically in the mid-and high-altitude areas during 1995–2014,the well-known global warming hiatus period.In particular,the maximum temperature increases much faster than that of average temperature.This result implies that the regional temperature trend could be apparently different from the global mean temperature change.

Can Current AGCMs Reproduce Historical Changes in the Atmospheric Diabatic Heating over the Tibetan Plateau?

Recent studies have demonstrated a persistent decreasing trend in the spring sensible heat(SH) source over the Tibetan Plateau(TP) during the past three decades. By comparing simulations from nine state-of-the-art atmospheric general circulation models(AGCMs) driven by historical forcing fields with both observational data and five reanalysis datasets, the authors found that the AGCMs are unable to reproduce the change in the SH flux over the TP. This deficiency arises because the observed decreasing trend in SH flux depends primarily on the change in surface wind speed according to the bulk formula, whereas in the models it is also influenced largely by changes in the land-air temperature difference related to the systematic cold bias. In addition, an obvious discrepancy exists in other aspects of the diabatic heating simulated by the models, suggesting that a significant improvement is required in the physical schemes associated with land surface processes and diabatic heating over the complicated topography.

Observed trends in diurnal temperature range over Nigeria

The long-term trend of diurnal temperature range(DTR)over Nigeria was examined using daily station-based datasets for the period 1971–2013.The results show that the regionally averaged DTR has decreased significantly(-0.34°C per decade)over the Nigerian Sahel(north of 10°N),but there has been a slight increasing trend(0.01°C per decade)over the Nigerian Guinea Coast.The annual decreasing trend of DTR in the Nigerian Sahel is mainly attributable to the significant increasing trend in daily minimum temperature(Tmin,0.51°C per decade),which far outstrips the rate of increase in the daily maximum(Tmax,0.17°C per decade).In contrast,the comparable trends in Tmin(0.19°C per decade)and Tmax(0.20°C per decade)may explain the non-significant trend of the DTR averaged over the Guinea Coast region.It is observed that the DTR has decreased more in boreal summer(June–July–August)than in boreal winter(December–January–February)for the regions.Furthermore,it is found that the significant DTR declining trend over the Nigerian Sahel is closely associated with an increasing trend of annual and summer precipitation in the region,but the increasing DTR trend in the Nigerian Guinea Coast region can be attributed to the decreasing trend of cloud cover over the region.

Preliminary Study on Element Leaching and Current Soil-Forming Process of Red Soils

The leaching characteristics and the element concentration in soil solution of red soils derived from sandstone,granite,Quaternary red clay and basalt have been studied in the Red Earth Ecological Experimental Station,Academia Sinica,using 12 lysimeters.Results obtained show that the element leaching process of red soils occurs mainly from January to the beginning of July annually.The elements with higher concentration in leaching solution of red soils are Si,Ca,Na,K,Mg,and N.The desilication and the leaching process of base cations occur simultaneously in the red soils.Using the first order differential equation and measured parameters of Si leaching,the leaching models of Si for red soils derived from different parent materials are constructed.The leaching process of Si is simulated with the models.Both the absolute and relative ages of red soils derived from different parent materials are discussed based on the simulation result.On the basis of element leaching,composition of soil solution and thermodynamics,the current soil-forming process is discussed.According to the phase diagram,the kaolinization is prevailing in the current formation of different red soils.

Research on development trend of Higher Vocational Students＇ Psychological Health

According to five consecutive year＇ s mental Health survey for freshmen in a higher vocational school, it is found that： vocational students＇ mental health is gradually improved; the most prominent psychological problems among higher vocational students are： compulsion, depression and interpersonal communication; boys＇ mental health is significantly better than girls＇ ; students from different grades have varies mental health problems.

A Preliminary Analysis of the Relationship between Precipitation Variation Trends and Altitude in China

Characteristics of the relationship between precipitation variation trends (PVT) and altitude were analyzed using monthly mean precipitation data from 526 observation stations in China from 1961 to 2008.With respect to elevation,China was divided into three subregions,below 200 m,200-1500 m,and above 1500 m.The results showed that the correlations between annual PVT and altitude are different among the three regions.In the region below 200 m in elevation,the best relationship has a correlation coefficient of-0.19 (0.49),passing the 90% (99.9%) significance level south (north) of 35 N.However,the correlation coefficient is close to zero,and the latitude strongly governs the spatial distribution of the amplitude of annual PVT in the 200-1500-m elevation region.In most of the Tibetan Plateau,where the elevation is greater than 1500 m,there is a weak negative correlation.The Mann-Kendall method was used to test the trend of regional mean annual precipitation,which indicated that the annual mean precipitation had no obvious trend of change in China due to the reverse significant variation trends in different areas of the country.

Inhomogeneous trends in the onset date of extreme hot days in China over the last five decades

Using a homogenized daily maximum temperature(T_(max))dataset across China,this study characterized the spatiotemporal variation of the onset date of extreme hot days in a year(i.e.,FirstEHD)during 1960-2018.Inhomogeneous trends of FirstEHD over China during 1960-2018 can be found,with the advanced trend of FirstEHD over most parts in China,while a number of stations in North-Central China(NC)show the delayed trend of FirstEHD.Moreover,there exist interdecadal changes of FirstEHD trend,with a remarkable difference in the trend magnitude before and after the 1990s over South China(SC),and the sign of trend can even reverse from negative to positive after the 1990s in Xinjiang(XJ)and Yangtze River Basin(YR),and from positive to negative in NC.The overall trends of FirstEHD over NC,YR,and XJ during 1960-2018 are dominated by the trends before the 1990s,while they are dominated by the sharp advance after the 1990s over SC.It is further found that the trend of FirstEHD can generally be explained by the long-term trend in T_(max) over most parts of China,but the contribution from T_(max) variabilities is also non-negligible and can even account for more than 75% of the overall trend over NC.The possible factors responsible for the decadal changes in FirstEHD trends are also discussed.

Analysis on the Development Trend of the Art Education in Higher Vocational Colleges

Higher vocational colleges are an important part of higher educational institutions, and train a large number of high-quality skilled personnel each year and solve the personnel demand problems of enterprises and other employing units. In recent years, art is not ordy a popular program in higher vocational colleges, but also an academic specialty difficult to control in higher vocational education. Because of the special characteristics of art, higher vocational colleges should combine with the future development trend of art education in the process of making a flexible teaching reform strategy, but should be no longer only be limited to the current teaching reform, so that the demands on the training of professional art personnel in a different period of times can be fulfilled.

China＇s Industrial Competitiveness and Evolving Trends on the World Market--- Analysis Based on Commodities Export Data

On the basis of classification of technology content for export goods＇, this＇ paper employs the latest trade statistics to examine the situation and evolving trend of China＇s industrial international competitiveness. Results indicate that.＂ （1） ranked by the order of low-, medium- and high-technology content, international competitiveness of China＇s industrial manufactured products is in a U-shaped distribution pattern; （2） distance between China＇s export advantage products and products with potentials is relatively small, which provides favorable micro-basis for steady transformation of export structure; （3） medium- and high-technology manufactured products including machinery and transport equipment will lead the upgrade of China＇s export,＂ and （4） countries in south Europe, transitional countries of the Central and Eastern Europe, and lndia will challenge China＇s leading position in low-technology products; China will compete with advanced countries of Europe in the area of medium-technology manufactured products and needs to catch up with and overtake the United States, and the developed economies in Europe and East Asia in the area of high-technology manufactured products. In order to enhance China＇s industrial international competitiveness, the government should pay great attention to the issue of the lack of competitiveness and low product density of medium-technology manufactured products, objectively view the dual effect of labor-intensive manufactured products in the upgrade of China＇s export structure, timely optimize policy portfolio for high-technology industries and give the highest priority to climbing up the value chain.

Characterizing the Spatio-temporal Dynamics and Variability in Climate Extremes over the Tibetan Plateau during 1960–2012

Extreme climate events play an important role in studies of long-term climate change. As the Earth’s Third Pole, the Tibetan Plateau(TP) is sensitive to climate change and variation. In this study on the TP, the spatiotemporal changes in climate extreme indices(CEIs) are analyzed based on daily maximum and minimum surface air temperatures and precipitation at 98 meteorological stations, most with elevations of at least 4000 m above sea level, during 1960–2012. Fifteen temperature extreme indices(TEIs) and eight precipitation extreme indices(PEIs) were calculated. Then, their long-term change patterns, from spatial and temporal perspectives, were determined at regional, eco-regional and station levels. The entire TP region exhibits a significant warming trend, as reflected by the TEIs. The regional cold days and nights show decreasing trends at rates of-8.9 d(10 yr)-1(days per decade) and-17.3 d(10 yr)-1, respectively. The corresponding warm days and nights have increased by 7.6 d(10 yr)-1 and 12.5 d(10 yr)-1, respectively. At the station level, the majority of stations indicate statistically significant trends for all TEIs, but they show spatial heterogeneity. The eco-regional TEIs show patterns that are consistent with the entire TP. The growing season has become longer at a rate of 5.3 d(10 yr)^-1. The abrupt change points for CEIs were examined, and they were mainly distributed during the 1980 s and 1990 s. The PEIs on the TP exhibit clear fluctuations and increasing trends with small magnitudes. The annual total precipitation has increased by 2.8 mm(10 yr)^-1(not statistically significant). Most of the CEIs will maintain a persistent trend, as indicated by their Hurst exponents. The developing trends of the CEIs do not show a corresponding change with increasing altitude. In general, the warming trends demonstrate an asymmetric pattern reflected by the rapid increase in the warming trends of the cold TEIs, which are of greater magnitudes than those of the warm TEIs. This finding indicates a positive shift in the distribution of the daily minimum temperatures throughout the TP. Most of the PEIs show weak increasing trends, which are not statistically significant. This work aims to delineate a comprehensive picture of the extreme climate conditions over the TP that can enhance our understanding of its changing climate.