目的:了解吉林省基层医疗卫生机构居民就诊满意度现状,分析卫生资源及服务能力因素对居民就诊满意度的影响,为提升基层卫生机构居民就诊满意度、改善卫生服务质量提供参考.方法:对吉林省12家基层医疗卫生机构及其就诊居民进行问卷调查,通过描述性分析、单因素分析和多重线性回归对居民满意度的影响因素进行分析.结果:居民就诊满意度总均分为(3.78±0.45),医疗机构卫生资源服务能力指标中就诊医疗机构医护比、工作年限≥20年卫生技术人员所占比例、辖区内每万服务人口的家庭医生团队数、基本药物配备比例对居民满意度有显著影响(P<0.05).结论:基层医疗机构卫生资源及服务能力因素会对居民就诊满意度产生影响,提示应进一步落实分级诊疗和国家基本药物制度,建设家庭医生团队,完善卫生人力资源配置,进而提高居民就诊满意度.

目的:探究居民感知服务质量的潜在类别,分析其与基层卫生服务利用关系,为改善基层医疗机构服务质量,提升居民基层卫生服务利用提供理论依据.方法:对吉林省基层医疗机构就诊的1344名居民进行问卷调查,采用潜在剖面分析的方法对居民感知卫生服务质量进行分类,利用二分类logistic回归分析研究居民感知服务质量与基层卫生服务利用的关系.结果:居民感知服务质量分为高、中、低3个潜在类别组,分别占总人数的15.8％,71.0％和13.2％.在控制人口学特征后,感知服务质量潜在类别组是居民过去一年就诊次数和持续就诊时长的影响因素,高感知服务质量组的居民就诊次数更多、持续就诊时长更长(P<0.05).结论:感知服务质量是居民选择利用基层卫生服务的重要因素,基层医疗机构需要不断增强服务能力,提髙卫生服务质量,从而促使居民选择基层医疗机构就诊.

为了迅速、准确地识别运动想象的脑电信号,提出了一种基于平移窗的运动想象脑电信号活动段提取方法.该方法对运动想象脑电信号Mu/Beta节律的事件相关同步化/去同步化(ERS/ERD)特征进行检测,提取ERS/ERD特征明显的时段;再利用统计量进行特征提取,通过Classify分类器进行信号分类.利用2003年BCI竞赛data set Ⅲ进行测试,分类准确率达到83.571 4％.该方法可以评价受试者的脑活动状态,提高运动想象脑电信号的识别准确率,对脑-机接口实时控制系统的研究有一定的帮助.

为提高手写汉字的识别率,针对手写汉字的有效分割,建立了卷积神经网络手写汉字体识别模型,并对投影法和轮廓检测法的适用性进行了对比分析.实验结果显示,相较于轮廓检测法,投影法更适用于手写汉字识别中对文字图像的处理工作,可以实现对所需文字的有效切分,同时简化手写汉字识别网络的设置并提高识别准确率.

目的:了解吉林省医疗卫生资源的配置及公平性状况,为优化医疗卫生资源配置和区域卫生发展规划提供参考依据.方法:对吉林省2018年医疗卫生资源的配置状况进行统计描述;利用基尼系数和泰尔指数分析吉林省医疗卫生资源配置的公平性.结果:按人口配置,吉林省全省及其东、中、西部地区医疗卫生资源的基尼系数均在0.2以下,总泰尔指数在0.140-0.280之间,区域间差异贡献率为53.7％-66.1％;按地理配置,吉林省东、中、西部地区基尼系数均在0.4以下,吉林省的总泰尔指数在0.939-1.208之间,区域间差异贡献率为49.0％-58.1％.结论:吉林省医疗卫生资源配置不均衡,按人口数量配置的公平性优于按地理面积配置,公平性差异主要来源于区域间差异.

Under China's healthcare reforms, community health service centres (CHCs) have been established as the preferred primary care providers. Even with this change, there is still little attention paid to patients' usual source of care (USC) from CHCs in Northeastern China. The main purposes of this study were to explore the determinants of usual source of community health service and to examine the association between usual source of community health service and patients' experiences with primary care. A cross-sectional survey with 515 adult patients at CHCs in Jilin Province, China, was conducted between July 2016 and November 2016. The patients' experiences with primary care were assessed with the Primary Care Assessment Tool (PCAT). Patients with self-perceived poor health status (odds ratio = 1.984, 95% confidence interval = 1.145-3.437) and chronic disease (odds ratio = 2.207, 95% confidence interval = 1.203-4.051) were more likely to have a usual source of community health service than patients with self-perceived good health status or without chronic disease. Patients scored the highest on comprehensiveness of services available (Mean = 2.87) and the lowest on community orientation (Mean = 1.83) in all domains of the PCAT, with values ranging from 1 to 4. A multiple linear regression analysis revealed that patients with a usual source of community health service had significantly higher overall scores than those without (B = 0.205, p < .001). This study demonstrated the important role of CHCs in providing affordable health services for patients with chronic disease or poor health status. Moreover, patients who chose a CHC as a USC had better experiences with primary care compared with patients who did not choose a CHC as a USC. However, community-oriented services need to be improved, and efforts to improve patients' experiences should include policies that incentivise patients to adopt a CHC as their USC.

绿色技术创新影响制造业转型升级的路径随着环境规制水平的变化而变化,因而有必要基于环境规制的视角系统地分析绿色技术创新对制造业转型升级的影响.研究发现,当环境规制水平较低时,绿色技术创新对于其他形式的技术创新具有挤出效应,因此不利于制造业的转型升级.但是随着环境规制水平的不断提高,企业的绿色技术创新与其他技术创新实现互补,制造业的转型升级进入快速发展期.而随着环境规制水平的进一步提高,绿色技术创新趋于成熟,制造业的转型升级进入低速稳定期.与此同时,相对于对大气污染的环境规制,提高对水污染的环境规制水平更有利于发挥绿色技术创新对于制造业转型升级的促进作用.

设计了一套基于表面肌电信号(sEMG)的非接触式操控手机系统.利用STM32控制表面肌电电极采集sEMG,通过在执行不同手势时sEMG本身的差异,使用BP神经网络分类器实现手势识别并操控手机.实验结果表明,该系统具有良好的稳定性,且响应速度快,平均识别率达到92％,符合预期.

目的:了解我国中老年群体首诊医疗机构选择行为状况及其影响因素,为促进分级诊疗制度的实施和医疗卫生事业的可持续发展提供理论依据和可行性建议.方法:基于2013年和2015年中国健康养老追踪调查(CHARLS)数据,运用χ2检验比较不同特征中老年群体首诊医疗机构选择行为的差异,运用logistic回归分析影响中老年群体首诊医疗机构选择行为的主要因素.结果:61.88％的中老年居民首诊医疗机构为基层,38.12％首诊医疗机构为医院.居住地、受教育程度、收入、社会医疗保险类型和慢性病状况对中老年居民首诊医疗机构选择行为具有显著影响.结论:我国中老年群体基层首诊率有待提高,可通过实现城乡医保统筹、增加基层门诊报销比例、加强基层慢性病规范管理和提高基层卫生服务能力等提高基层首诊率.

目的:了解辽宁省某县级医院老年循环系统疾病患者住院费用构成及其影响因素,为降低住院费用提供参考.方法:运用中位数和四分位数描述住院费用构成及在不同特征人群中的分布状况.运用秩和检验进行组间比较,并运用多元线性回归分析循环系统疾病老年患者住院费用的影响因素.结果:在住院费用中,药费居于首位(1901元),其次为诊疗费(1000元)和综合服务费(753元).多元线性回归分析表明住院天数、是否手术和付费方式对住院费用有显著影响.结论:应加强医院内部管理,强化政府责任,加强医疗保险的监管,提高老年人疾病预防和治疗意识,以降低住院费用.

目的:调查长春市某高校大学生社交焦虑现状,分析其影响因素,为制定社交焦虑的干预措施提供依据.方法:采用方便抽样法抽取长春市某高校公共卫生学院820名本科生进行问卷调查.结果:大学生社交焦虑总体水平偏高(42.90±9.31),学生的家庭人均年收入、月均消费水平、家庭所在地以及是否是学生干部、是否恋爱对社交焦虑水平的影响有显著差异(P<0.05).社交焦虑高分组的大学生无聊倾向得分高于社交焦虑低分组,社会支持得分则低于社交焦虑低分组,差异有统计学意义(P<0.05).多元线性回归分析显示,无聊倾向程度对社交焦虑有显著的正向预测作用(P<0.05),社会支持对社交焦虑的预测作用不显著(P>0.05).结论:应采取有针对性的综合改善策略,减轻大学生的社交焦虑,促进其身心健康.

患者参与社区卫生服务就诊过程,对于保障自主权、增强就诊体验、制定个性化诊疗方案、降低医疗费用、促进社区卫生服务机构的发展具有重要的作用.目前,我国患者参与社区卫生服务的积极性较低,机构缺乏患者参与的支持环境.社区卫生服务机构可以通过健康教育等方式增强患者参与就诊过程的积极性,制定参与制度,重视患者的个体差异,为患者参与就诊过程提供服务环境及政策支持.

Bilateral absence of the superior vena cava (SVC) is a very rare congenital vascular anomaly that is mainly asymptomatic. In this report, we describe an adult male patient with bilateral absence of the SVC presenting with SVC syndrome. Blood from the upper body returned to the right atrium via the superficial thoracoepigastric veins, the great saphenous veins, the common femoral veins, and the inferior vena cava.

改革开放后,中国踏上了具有本国特色的社会主义道路.经过四十余年的发展,中国道路愈发彰显本国特色,凭借其新颖的结构、丰富的内容成功博得了世界的眼球.迈入新时代后,中国道路的结构性维度越发清晰,它以实现中华民族伟大复兴为发展目标,在"四个全面"这一顶层设计的指导下开展"五位一体"全方位总布局."四个全面"与"五位一体"如同纵横全图的经纬线,围绕中国梦的宏伟目标编织出了一条壮丽的中国道路.

Some multi-ether linked polyimides (PIs) derived from two diamine monomers containing various amount of cyano groups are synthesized by a typical two-step polymerization. Meanwhile, the PIs with similar chemical structure but without cyano groups are prepared as counterparts for comparison purposes. The obtained PIs exhibit low glass transition temperature values of 211–258°C, which are associated with their multi-ether chemical structure. Furthermore, these PIs have high thermal stability, and the temperatures at 10% weight loss are in the range of 524–616°C under nitrogen atmosphere. It is found that the introduction of cyano groups would have a great influence on the properties of the PIs. The tensile strength and Young’s modulus of one cyano-containing PI reach 121 MPa and 1.4 GPa, respectively, which are much higher than those cyano-free ones. In addition, the cyano-containing PIs exhibit different behaviors of dielectricity and solubility in comparison with the corresponding cyano-free counterparts.

为了提高本科实验实践教学效率,结合连续与离散控制系统课程特点,论文提出一套基于PID的滚球控制系统实验平台.该实验教学平台,以PID算法作为控制方式,通过目标物设定与运动状态的实时反馈,完成滚球的闭环控制.在实验实践教学中,学生通过直观观测与分析、计算与调节,综合验证控制效果,进而加深理论知识的理解,提高动手实践能力.

The advances in surface-enhanced Raman scattering (SERS) have resulted in significant improvements for sensing glucose, achieving a highly detecting sensitivity of the order of mu M. Highly sensitive glucose detection, however, is still a challenge due to extremely small Raman scattering cross section of glucose molecules and weak interaction between the molecules and the metal nanoparticles. Here, we designed a novel homogeneous SERS-based nanoplatform composing of the SERS tags and glucose oxidase in aqueous solution for a highly sensitive glucose detection. Adding glucose caused enzymatic oxidation reaction to etch the tip electric field (E) of silver nanotriangle. Thus, the decreased intensity of E was greatly amplified by the change of SERS signal (E-4 dependent), which resulted in an excellent glucose detection limit of 0.4 nM was firstly achieved. Furthermore, the nonlinear relationship between the decreased SERS intensity and the glucose concentrations was reasonably revealed based on theoretical calculations and deeply understanding of the enhancement mechanism, which is very useful in improving the sensitivity and accuracy of trace glucose detection. The as-prepared nanoplatform showed good sensitivity and high selectivity only through observing the SERS intensity change, which is potential for highly sensitive and practical glucose detection for clinical trace analyses.

Objective: To understand the evaluation of primary medical and health service quality by the medical staff in Changchun City, analyze the problems existing in the basic level medical and health institutions, and explore ways to improve the quality of primary medical and health service. Methods: The TOPSIS and RSR methods were used to evaluate the quality of primary medical and health service in 9 community health service centers (A-I) and 2 township hospitals (J, K) in Changchun. Results: In TOPSIS method, H community health service centerranked the best and K community health service center ranked the worst. The results of RSR methodhowed that K was poor (Probit＜4), J and H were excellent (Probit＞6), and the others were middle (4＜Probit＜6). Conclusion: The combination of TOPSIS and RSR methods can better evaluate the quality of primary medical and health service. There are differences in the quality of medical services among primary health care institutions. The primary medical and health service need to improve the first diagnosis and continuity indexes.

目的:了解实施家庭医生签约服务背景下,长春市社区医务人员的工作满意度情况,为进一步提高家庭医生工作积极性,完善家庭医生签约服务提出政策支持.方法:对长春市某城区9个社区卫生服务中心的医务人员进行工作满意度调查,分析影响工作满意度的因素.结果:社区医务人员总体工作满意度得分均值为(3.43±0.95)分,属于一般满意.影响社区医务人员总体满意度的因素为福利薪酬、责任感与成就感、组织管理.结论:社区医务人员总体工作满意度一般,福利薪酬满意度最低且对总体工作满意度影响显著;社区医疗卫生人力资源结构有待改进.建议以人为本,加强人力资源管理;不断完善绩效考核评价体系;薪酬分配基础上建立激励补偿.

Objectives: To determine the diagnostic performance of contrast-enhanced ultrasound, diffusion-weighted magnetic resonance imaging and contrast-enhanced magnetic resonance imaging for detecting colorectal liver metastases. Methods: We performed comprehensive searches of the MEDLINE, EMBASE, and Cochrane Library databases to identify studies reporting the per-lesion diagnostic accuracy of contrast-enhanced ultrasound, diffusion-weighted magnetic resonance imaging, and contrast-enhanced magnetic resonance imaging for detecting colorectal liver metastases. Studies published between January 2003 and December 2018 with reference standards, including histopathology and intraoperative observation, and/or follow-up, were included. Sources of bias were assessed using the QUADAS-2 tool. A linear mixed-effects regression model was used to determine sensitivity estimates. Results: Overall, 47 articles were included. The sensitivity estimates for contrast-enhanced ultrasound, diffusion-weighted magnetic resonance imaging, and contrast-enhanced magnetic resonance imaging for detecting colorectal liver metastases were 85.3%, 83.0%, and 90.1%, respectively. For lesions > 10 mm in diameter, the sensitivities were 93.1%, 92.9%, and 94.5%, respectively. In 21 articles using histopathology as the only reference standard, the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio for contrast-enhanced ultrasound/contrast-enhanced magnetic resonance imaging were 86%/91%, 91%/95%, 9.2/16.6, 0.15/0.10, and 61/170, respectively. Conclusions: CEUS showed a diagnostic ability comparable to that of DWI and CEMRI, particularly for lesions >= 10 mm in diameter. (C) 2019 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.