Joint analysis of nonlinear heterogeneous longitudinal data and binary outcome: an application to AIDS clinical studies

Finite mixture models are currently used to analyze heterogeneous longitudinal data. By releasing the homogeneity restriction of nonlinear mixed-effects (NLME) models, finite mixture models not only can estimate model parameters but also cluster individuals into one of the pre-specified classes with class membership probabilities. This clustering may have clinical significance, which might be associated with a clinically important binary outcome. This article develops a joint modeling of a finite mixture of NLME models for longitudinal data in the presence of covariate measurement errors and a logistic regression for a binary outcome, linked by individual latent class indicators, under a Bayesian framework. Simulation studies are conducted to assess the performance of the proposed joint model and a naive two-step model, in which finite mixture model and logistic regression are fitted separately, followed by an application to a real data set from an AIDS clinical trial, in which the viral dynamics and dichotomized time to the first decline of CD4/CD8 ratio are analyzed jointly.     

Vitamin A and Infant Mortality: Beyond Intention-to-Treat in a Randomized Trial

This paper investigates the effect of one dose of vitamin A on subsequent 4 month mortality in children under 6 months of age in a randomized, double-blind placebo-controlled community trial in Nepal. An earlier published intention-to-treat analysis showed no benefit, but ignored the information on actual receipt of treatment. Structural failure time models (Robins and Tsiatis, '91) use randomization based inference and incorporate compliance information which is possibly selective. The data presented here offer some new challenges for this approach: ward-based randomization induces correlation between survival outcomes; and the actual receipt of vitamin A dose is not always recorded. To tackle the problem of the clustered survival data we consider a robust version of the structural parameter vector estimator. A sensitivity analysis captures boundaries for the estimated structural parameters reflecting a range of potential values of children whose true receipt of treatment is unknown. The analysis suggests that the effect of vitamin A was beneficial in the beginning of the trial but towards the end of the trial there was a reversal of this effect.     

Globalising Chinese Medical Understandings of Menopause

This essay examines the treatment of menopausal syndrome by Chinese medicine as a window on how globalisation impacts on the development of the Chinese medical tradition. The treatment strategies for menopausal syndrome were invented in 1964 and betray a strong influence of biomedical thinking. Today, they are sold both at home and abroad as products of 2,000 years of clinical experience. Close examination of textual sources reveals that such attachment is achieved by way of skillfully patching selected elements of tradition onto each other, creating a narrative that appears coherent and fits biomedical models of menopause, but is intrinsically fragile. Not only can the patchwork that sustains this narrative easily be deconstructed (as for instance in this article) but having attached itself to a distinctive interpretation of ageing—universal, biological and chauvinist—it also opens itself up to all of the criticisms that have been made of biomedical models of menopause insensitive to local variations in women’s experience. Furthermore, there is no evidence that modernising Chinese medical interpretations of menopause have increased its effectiveness in clinical practice. Whilst the essay itself does not seek to resolve these tensions, it demonstrates that the globalisation of Chinese medicine provides it not merely with opportunities but also with important new problems whose resolution may determine its ongoing development—and indeed survival—as a living tradition.

非物质文化遗产视域下中医药知识产权保护的困境与路径

中医药是世界上最为独特的医药学体系之一,是历史传承中的无价之宝,其遗传资源、制作技艺等已成为我国非物质文化遗产重要的组成部分。2011年施行的《中华人民共和国非物质文化遗产法》提出了对非物质文化遗产的知识产权保护;2017年《中华人民共和国中医药法》的施行,延续了知识产权保护这一重要工具。这些法律在一定程度上相互协同,保障和促进了我国中医药行业的发展。但梳理当前我国对中医药保护的现状,中医药的非遗认知度、专利申请积极性、商业秘密保护严谨性以及中医药的技术传承等诸多问题一直困扰着我国中医药行业的发展。这并未完全达到对于中医药知识产权进行保护的立法目的。文章基于非物质文化遗产的视角提出制定中医药特殊保护制度、协调权利冲突、加强传承以及明确监管等解决路径,剖析原因,以期有助于推动我国中医药行业的发展。     

戴笠、陈明德事迹考

我国清末同情太平天国革命的学者王韬(1829-1897)在所著<扶桑游记>中说,明亡后至日本的朱之瑜、陈元赟和戴笠是当时在日本最有学问的三人.朱之瑜作为水户藩主德川光国的师宾,传播儒家学说,陈元赟据道家哲学思想,创传柔道、传播公安派文学,戴笠虽削发为僧,却不忘救人济世,发明救治痘疹,与他同时的陈明德也是以医术起废愈痼,为中日文化交流作出了卓越的贡献.     

开发与保护我国中药知识产权的几个问题

中药是中华民族的瑰宝。中药作为特殊的商品,随着世界医药市场的竞争,其知识产权被侵犯的事例多有发生。开发与保护中药知识产权的战略和策略问题已成为迫切的课题。     

基于PLS的广东社区中医药服务公众满意度研究

目的:参考顾客满意度指数模型建立社区中医药服务公众满意度结构方程模型,以广州、深圳、汕头、惠州和湛江5个城市为例,对广东省社区中医药服务现状进行分析。方法:以偏最小二乘法(PLS)为拟合方法,开展广东省社区中医药服务公众满意度的实证研究。结果:广东省社区中医药服务公众满意度结构方程模型拟合度理想,具有可行性。结论:针对测评结果提出要进一步推动社区公众满意度测评,提高社区中医药服务的综合质量,改善影响满意度的重要因素。     

在七年制临床专业学位硕士生中开展教学工作的探讨

七年制研究生教育是目前国内医学教育中的精品部分,如何培养合格的高素质人才是当前医学高等教育的重要工作。当前各院校均通过加强临床能力的带教,落实考核内容,把住培养质量的出关口来保证七年制的培养质量。文章通过在七年制临床专业学位研究生中开展临床教学工作,提高研究生的临床技能,把握临床专业学位研究生培养质量的出关口。     

关于临床医学专业本科毕业生就业的思考

文章通过问卷调查了解了临床医学专业本科学生就业面临的主要问题,分析原因,提出相应对策,强调要进一步加强毕业生就业指导工作,实现临床医学专业本科毕业生最大限度的就业。     

医学生临床实践技能和综合能力培养的探索

探索新的教学方法、教学手段和考核方式,通过对学生临床实践技能的培训和综合素质的教育,使医学生在临床实践技能和综合知识方面均得到提高和强化,同时紧紧围绕国家执业医师资格考试,让学生提前得到熟悉和适应,有利于将来的临床工作和服务于社会。