目的 分析上海市A区3所区属公立综合医院3个代表性病种的住院抗菌药物的使用合理性.方法 通过病案评阅,分析3个代表性病种的抗菌药物使用的合理性.结果 住院急性单纯性/化脓性阑尾炎(行腹腔镜阑尾切除术)、社区获得性肺炎和输尿管结石(行输尿管镜碎石取石术)的抗菌药物使用不规范且医院间存在较大的差异,有预防性抗菌用药不合理或抗菌药物用药超量的问题.结论 应通过强化管理改变医疗机构及其临床医师抗菌药物的不合理使用习惯.

Objective:To analyze the effects of prescription reviews of key monitored drugs using the drug regulatory platform in a district of Shanghai, and the influencing factors for the rate of unqualified prescriptions.Methods:A drug regulatory platform in a district in Shanghai began to implement prescription reviews since June 2018, extracting the reviewed prescriptions of all key monitored drugs and related information from June to December. Taking the unqualified rate of prescription in June as the baseline data, the χ2 test and the logistics regression model were used for data analysis. Results:From June to December 2018, clinical pharmacists reviewed 19 084 outpatient and emergency prescriptions and 10 607 inpatient prescriptions. The unqualified rates of outpatient and emergency prescriptions and inpatient prescriptions dropped from 16.52% and 23.28% in June to 4.45% and 13.80% in December, respectively. Logistics regression analysis showed that the rate of unqualified reviews of outpatient and emergency prescriptions was lower than that of inpatient prescriptions, and the rate of unqualified prescriptions in hospital was significantly lower than that in community health service centers; the rate of unqualified prescriptions for auxiliary drugs and nutritional drugs was significantly lower than that of antibacterial drugs.Conclusions:The prescription reviews of key monitored drugs can effectively promote the rational use of drugs. In the future, it is recommended to strengthen technical support for community health service centers and professional training for clinicians and pharmacists.

目的 了解沪兰两地公众对精准医学及其技术利用中伦理问题的认知,为我国精准医学技术的发展和利用提供决策依据.方法 通过对上海市和兰州市社区居民和医院患者进行问卷调查,并采用卡方检验和logistic回归分析,比较不同人群对精准医学及其技术利用中伦理问题的认知差异,探究可能的影响因素.结果 对沪兰两地2250名公众的调查结果显示,公众对隐私保护、知情同意和精准医学技术的合理定价较为关注.结论 我国应加强对精准医学技术利用的全过程监管,特别是个人隐私(基因信息)保护和知情同意的实施,以保障公众权益.

目的 分析上海市和兰州市的公众对精准医学技术纳入基本医疗保险的接受度和公平性的认知,为我国精准医学技术相关医疗保险政策的制定提供决策依据.方法 通过对沪兰两地社区居民和医院患者的问卷调查、公众代表访谈与专家咨询收集研究数据,分析我国不同人群对精准医学技术纳入基本医疗保险的可接受度和公平性的认知,采用卡方检验和logistic回归分析,比较不同人群的认知差异.结果 87.00％以上的被调查者认为基因检测、靶向治疗和免疫治疗应该纳入基本医疗保险报销目录,30.00％～40.00％的被调查者认为将这些技术纳入基本医疗保险会对基本医疗保险经费使用的公平性产生影响.咨询专家一致认为,多渠道的医疗保障可确保基本医疗保险经费使用的公平性.结论 需客观评价精准医学技术纳入基本医疗保险的公平性.

目的 了解沪兰两地公众对非小细胞肺癌相关精准医学技术的认知,为我国精准医学技术的发展和利用提供决策依据.方法 通过对上海市和兰州市社区居民和医院患者的问卷调查以及公众代表访谈收集研究数据,采用卡方检验和logistic回归,比较不同人群对非小细胞肺癌相关精准医学技术(基因检测、靶向治疗、免疫治疗)的认知差异.结果 仅49.90％～57.65％的被调查公众了解非小细胞肺癌相关的精准医学技术,但被调查公众对这些技术的接受度较高(约90.00％).结论 为了保护患者的权益,应向公众广泛宣传精准医学技术,并重视临床应用前后的技术评估.

目的 研究上海市浦东新区计算机断层扫描(computed tomography,CT)、磁共振成像(magnetic resonance imaging,MRI)和数字减影血管造影(digital subtraction angiography,DSA)设备利用的适宜性及其影响因素.方法 在该区9所公立医院中,随机抽取和检查了1425份接受过CT、MRI和DSA检查的住院病案.专家根据检查表,对设备利用的适宜性进行评价.结果 在CT、MRI、DSA检查中,87.08％、87.68％和96.17％的检查是适宜的;分层logistic回归显示,医疗机构、疾病类型、检查次数是CT和MRI检查必要性的影响因素.结论 上海市浦东新区三类设备利用适宜性整体较高,但应关注不同疾病类型和不同医院间的CT和MRI设备利用合理性的差异.

Objective To analyze the allocation and utilization of class-B large medical equipments at public hospitals under Pudong New Area,Shanghai.Methods Data on the allocation and utilization of class-B large medical equipments were collected by a questionnaire survey of 17 public hospitals under Pudong New Area from June to July 2017 and were analyzed in descriptive statistics.Results There were 55 units of class-B large medical equipments at the public hospitals under by Pudong New Area.The average utilization rates of MRI,CT and DSA were 52.62％,61.49％ and 24.43％ respectively.Conclusions The number of class-B large medical equipments has increased at such hospitals,but the services using DSA need to be extended.

Nanoparticle formation and growth driven by acid-base chemistry was investigated by introducing gas-phase sulfuric acid (H2SO4) with ammonia (NH3) or dimethylamine (DMA) into a flow tube reactor. A thermal desorption chemical Ionization mass spectrometer was used to measure the size-resolved chemical composition of H2SO4-DMA and H2SO4- NH3 nanoparticles formed under dry conditions and at 60% relative humidity. In contrast with predictions for bulk aqueous systems, nanoparticles showed a strong size-dependent composition gradient and did not always reach a fully neutralized state in excess of gas-phase base. Smaller particles were more acidic, with an acid:base ratio of 0.70.1 and 1.3 +/- 0.3 for 8.6 and 9.5nm H2SO4-DMA particles formed under dry and humid conditions, respectively, and 3.1 +/- 0.6 and 3.4 +/- 0.3 for 7.5nm H2SO4-NH3 particles formed under dry and humid conditions, respectively. The acidity of particles generally decreased as particles grew. H2SO4-DMA particles became fully neutralized as they grew to 14nm, but H2SO4-NH3 particles at 12nm were still acidic and were never observed to reach bulk sample thermodynamic equilibrium for the experimental conditions in this study. Thermodynamic modeling demonstrated that the observed trends can be reproduced by modifying acid dissociation constants to minimize acid-base chemistry, which may be caused by steric or mixing effects, and by considering volatilization of the neutral base.Copyright (c) 2018 American Association for Aerosol Research

Objective To analyze the allocation and equity of Class-A and Class-B large medical equipment in Shanghai, and to compare them with those in other parts of China and in other OECD countries. Methods The data of large medical equipments were collected from the Health and Family Planning Commission of Shanghai, government websites, relevant research reports and the database of OECD. Gene-coefficients were adopted to evaluate the equity of large equipment allocation. Results In terms of Class-A and Class B large equipments like CTs, MRIs and DSAs per million population, the number for Shanghai by the end of 2015, was 1.325, 5.30, 2.13 and 3.81 units respectively. Except for CTs, this figure was higher than national average, yet lower than average of other OECD countries. In addition, the equity in allocation of Class-B large medical equipment was better than that of Class-A large medical equipment in Shanghai. Conclusions The overall deployment level of large medical equipments in Shanghai remains to be increased, and the equity in allocation of Class-A large medical equipment deserves more attention.

目的:分析上海市某三甲儿童专科医院的人员配置状况.方法:通过查阅医院统计年报,收集2013-2015年该医院的人力资源数据和运营数据.结果:2015年,医院共有卫生技术人员1342名,占人员总数的87.54％;30-34岁年龄组医师占比超过35％;初级职称的护士(师)占67.92％;超过75％的医技人员拥有本科或大专学历.重症医学科(包含急诊、输液中心)和新生儿科配置的医师数和护士(师)数最多;普外科、新生儿科、泌尿外科床位医师比最高;心血管科、泌尿外科、普外科护士(师)床位比最高.结论:该儿童专科医院的人员配置缺乏标准;医院人力资源总体结构合理,但仍面临挑战.

Objective To analyze the return on investment of 3 types of large medical equipments at Pudong's public hospitals in Shanghai.Methods Data on the numbers and purchasing expenditure, annual utilization headcounts, annual income and annual costs of the MRIs, CTs and DSAs were collected from these hospitals, and their breakeven points and recovery period were analyzed in the study. Results At these hospitals, CTs had relatively a higher return on investment in 2016, with 95 000 headcounts per hospital. At the interest rates of 1% , 3% and 5% , nine hospitals could recover their investment, at an average recovery period of 2.88 years, 3.23 years and 3.84 years respectively. That for DSS was poor. Conclusions These hospitals should improve the business performance of these equipments by means of rational purchase, enhanced utilization and sharing mechanism.

目的 分析计算机断层扫描(computed tomography,CT)和磁共振成像(magnetic resonance imaging,MRI)设备检查在上海市浦东新区区属公立医院临床诊疗中的作用.方法 在该区区属公立医院中随机抽取2016年出院且做过CT和MRI检查的病案1008份,对这两个设备的检查结果及其与临床诊断的一致性进行分析.结果 CT和MRI检查阳性率与检查必要性无同向的关联性;CT和MRI检查结果与临床诊断一致率需要控制;上海市浦东新区区属公立医院间的CT和MRI检查阳性率和一致率存在显著差异.结论 需要严格监控CT和MRI的利用.

目的 分析上海市浦东新区区属公立医院高额医用设备的配置与投资回收状况.方法 通过医院问卷调查,收集与分析了浦东新区区属公立医院2016年所有高额医用设备的配置与投资回收的相关数据.结果 浦东新区区属公立医院过1/3的高额医用设备为近年配置和由区财政拨款购置.综合性医院和专科医院主要高额医用设备的平均回收购置成本需要的年数分别为0.10～67.58年和0.53～23.26年.结论 高额医用设备购置与经济管理不容忽视,区域政府与公立医院应加强高额医用设备的宏观和微观管理.

Most prior field studies of new particle formation (NPF) have been performed at or near ground level, leaving many unanswered questions regarding the vertical extent of NPF. To address this, we measured concentrations of 11–16 nm diameter particles from ground level to 1000 m during the 2013 New Particle Formation Study at the Atmospheric Radiation Measurement Southern Great Plains site in Lamont, Oklahoma. The measurements were performed using a tethered balloon carrying two condensation particle counters that were configured for two different particle cut-off diameters. These observations were compared to data from three scanning mobility particle sizers at the ground level. We observed that 11–16 nm diameter particles were generated at the top region of the boundary layer, and were then rapidly mixed throughout the boundary layer. We also estimate liquid water content of nanoparticles using ground-based measurements of particle hygroscopicity obtained with a Humidified Tandem Differential Mobility Analyzer and vertically resolved relative humidity (RH) and temperature measured with a Raman lidar. Our analyses of these observations lead to the following conclusions regarding nanoparticles formed during NPF events at this site: (1) ground-based observations may not always accurately represent the timing, distribution, and meteorological conditions associated with the onset of NPF; (2) nanoparticles are highly hygroscopic and typically contain up to 50 % water by volume, and during conditions of high RH combined with high particle hygroscopicity, particles can be up to 95 % water by volume; (3) increased liquid water content of nanoparticles at high RH greatly enhances the partitioning of water-soluble species like organic acids into ambient nanoparticles.

微信作为一种新型的社交媒体,已经成为广大师生社会交往和获取信息的重要渠道.本研究以高校学生为调查对象,通过调查班级党建微信公众号的建设情况、学生对党建微信公众平台的态度以及党建微信公众平台存在的问题等内容,为更好地建设党建类微信平台提出可行性建议.

Correction for 'New particle formation and growth from methanesulfonic acid, trimethylamine and water' by Haihan Chen et al., Phys. Chem. Chem. Phys., 2015, 17, 13699-13709.

目的 分析上海市某三级甲等儿童专科医院(简称“A医院”)运营状况.方法 通过机构问卷调查和查阅医院统计年报,收集2013-2015年A医院运营数据.结果 2015年,A医院实际开放床位数为690张;卫生技术人员数为1 342名;总诊疗人次数为228.48万人次,治愈好转率为97.19％,出院者平均住院日为7.21天,门急诊均次费用为290.31元,医师年人均门急诊服务人次数为5 259.74人次;培养研究生204名,科研项目157项,18个重点学科.结论 A医院运营业务负荷较大,需要进一步推动儿科医联体的发展以缓解卫生技术人员的医疗服务压力.

目的:分析上海市某三级甲等儿童专科医院(简称"A医院")员工的工作满意度状况.方法:以Spector开发的工作满意度调查表为基础设计工作满意度调查表,对A医院450名员工进行问卷调查.结果:回收有效问卷374份.97.85%的被调查者平均每周工作时间在40 h以上.A医院员工总体工作满意度评分为2.81分(6分制),工作压力大是主要不满意因素.行政管理科室员工工作满意度相对较高(P<0.05),平均每周工作60 h及以上的员工工作满意度相对较低(P<0.05).结论:A医院员工的工作满意度较低,工作压力大是突出问题,需对满意度相对较低的科室和人员给予重点关注,加强医院的人力资源配置与规划.

Previous studies have shown that methanesulfonic acid (MSA) reacts with amines and ammonia to form particles, which is expected to be particularly important in coastal and agricultural areas. We present the first systematic study of temperature dependence of particle formation from the reactions of MSA with trimethylamine (TMA), dimethylamine (DMA), methylamine (MA), and ammonia over the range of 21-28 °C and 0.4-5.9 s in a flow reactor under dry conditions and in the presence of 3 × 1017 cm-3 water vapor. Overall activation energies (Eoverall) for particle formation calculated from the dependence of rates of particle formation on temperature for all of these bases are negative. The negative Eoverall is interpreted in terms of reverse reactions that decompose intermediate clusters in competition with the forward reactions that grow the clusters into particles. The average values of Eoverall for the formation of detectable particles are: TMA, -(168 ± 19) kcal mol-1; DMA, -(134 ± 30) kcal mol-1; MA, -(68 ± 23) kcal mol-1; NH3, -(110 ± 16) kcal mol-1 (±1σ). The strong inverse dependence of particle formation with temperature suggests that particle formation may not decline proportionally with concentrations of MSA and amines if temperature also decreases, for example at higher altitudes or in winter.

New particle formation (NPF) from gaseous precursors as a significant source of aerosol needs to be better understood to accurately predict the impacts on visibility, climate change, and human health. While ternary nucleation of sulfuric acid, amines/NH3, and water is recognized as a significant driver for NPF, increasing evidence suggests a contribution from methanesulfonic acid (MSA) and amines under certain conditions. Here we report the formation of particles 2.5-10 nm in diameter from the reactions of MSA with methylamine (MA), dimethylamine (DMA), and NH3 at reaction times of 2.3-7.8 s in a flow reactor and compare these particles with those previously reported to be formed from reaction with trimethylamine (TMA). The effects of water vapor and concentrations of gaseous precursors on the particle number concentration and particle size were studied. The presence of water significantly enhances particle formation and growth. Under similar experimental conditions, particle number concentrations decrease in the order MA ≫ TMA ≈ DMA ≫ NH3, where NH3 is 2-3 orders of magnitude less efficient than DMA. Quantum chemical calculations of likely intermediate clusters were carried out to provide insights into the role of water and the different capacities of amines/NH3 in particle formation. Both gas-phase basicity and hydrogen-bonding capacity of amines/NH3 contribute to the potential for particles to form and grow. Our results indicate that, although amines typically have concentrations 1-3 orders of magnitude lower than that of NH3 in the atmosphere, they still play an important role in driving NPF.