Statistical methodology for binary data from a set of partially structured two-way random cross-classifications

A complete two-way cross-classification design is not practical in many settings. For example, in a toxicological study where 30 male rats are mated with 30 female rats and each mating outcome (successful or unsuccessful)is observed, time and resource considerations can make the use of the complete design prohibitively costly. Partially structured variations of this design are, therefore, of interest (e.g., the balanced disjoint rectangle design, the fully diagonal design, and the "S"-design). Methodology for analyzing binary data from such incomplete designs is illustrated with an example. This methodology, which is based on infinite population sampling arguments, allows the estimation of the mean response, among-row correlation coefficient, among-column correlation coefficient, and the within-cell correlation coefficient as well as their standard errors.     

Indications for,and timing of,planned caesarean section: A systematic analysis of clinical guidelines

BackgroundThere has been a worldwide rise in planned caesarean sections over recent decades, with significant variations in practice between hospitals and countries. Guidelines are known to influence clinical decision-making and, potentially, unwarranted clinical variation. The aim of this study was to review guidelines for recommendations in relation to the timing and indications for planned caesarean section as well as recommendations around the process of decision-making.MethodA systematic search of national and international English-language guidelines published between 2008 and 2018 was undertaken. Guidelines were reviewed, assessed in terms of quality and extracted independently by two reviewers.FindingsIn total, 49 guidelines of varying quality were included. There was consistency between the guidelines in potential indications for caesarean section, although guidelines vary in terms of the level of detail. There was substantial variation in timing of birth, for example recommended timing of caesarean section for women with uncomplicated placenta praevia is between 36 and 39 weeks depending on the guideline. Only 11 guidelines provided detailed guidance on shared decision-making. In general, national-level guidelines from Australia, and overseas, received higher quality ratings than regional guidelines.ConclusionThe majority of guidelines, regardless of their quality, provide very limited information to guide shared decision-making or the timing of planned caesarean section, two of the most vital aspects of guidance. National guidelines were generally of better quality than regional ones, suggesting these should be used as a template where possible and emphasis placed on improving national guidelines and minimising intra-country, regional, variability of guidelines.     

服装专业产学研立体化教学模式研究与实践

从当前服装教研室在市场经济日趋完善状况下所存在的种种弊端着手,根据教学市场化规律来探寻一种适合市场经济的教学平台。通过构建工作室教学的市场化思路,来适应市场经济对服装专业人才综合素质的要求。     

画有法画无定法--浅议写实摄影构图的六个基本法则

在摄影过程中应遵循和运用黄金分割、三角形、对角线、天头留白、运动空白、均衡稳定等构图法则,方能使写实摄影作品获得较为理想的艺术效果.     

南京市妇幼保健院剖宫产率升高的影响因素及应对措施

目的:分析南京市孕产妇剖宫产升高的原因及其影响因素.方法:采用整群调查的方式收集南京市妇幼保健院产科2011年1～12月选择剖宫产的4 793名产妇及其家庭成员进行问卷调查.结果:剖宫产指征中社会心理因素占69.27％、经济因素(家庭收入和医疗保险等)占17.24％、医学指征因素占13.49％.高学历、高收入和高龄产妇选择剖宫产术显著高于普通产妇(P＜0.01).多因素Logistic回归分析显示,与选择剖宫产术相关的危险因素有年龄、受教育程度、家庭收入、医疗保险、婚姻状况、产妇及家庭心理干预.结论:加强孕产妇围产期保健及分娩知识宣教,强化高危人群的筛查和规范化管理,广泛开展无痛分娩和住院服务,正确把握剖宫产指征与时机,将有利于降低剖宫产率.     

心理干预联合音乐疗法对剖宫产患者应激水平的影响

目的：探讨心理干预联合音乐疗法对减轻患者的心理压力、缓解患者的手术疼痛、降低机体的应激水平所起到的积极作用。方法：将60例择期剖宫产患者随机分为对照组和干预组：对照组给予常规观察和护理措施,干预组除进行对照组的护理措施外另给予术前心理干预和术中音乐疗法。观察两组干预前后焦虑评分（SAS）、皮质醇（Cort）、血糖（Glu）水平变化及干预前后血压、心率、新生儿评分、患者满意度及疼痛值（VAS）水平变化。结果：两组在干预前SAS焦虑自评无明显差异,干预后干预组焦虑程度有所改善,低于对照组（P〈0.05）;两组Cort、Glu水平、VAS评分、患者满意度,干预组优于对照组（P〈0.05）;两组血压、心率及新生儿Apgar评分无统计学意义（P〉0.05）。结论：心理干预联合音乐疗法能有效缓解剖宫产患者的应激水平。     

试析京杭运河山东段在近代的衰落原因

京杭大运河有“人类历史奇迹”的美誉,是贯通我国南北水运的大动脉。千百年来,在政治、经济、军事、文化等方面发挥了重要作用,成为维系中国大一统局面的政治纽带,大运河也呈现出盛极一时的繁荣局面。但清末至民国时期,由于航道淤塞、黄河改道、漕粮河运改为海运等自然、社会原因,京杭运河一度走向衰落。本文选取京杭运河主要是山东运河在近代以来的衰落情况及其原因作简单分析。     

辽朝黑龙江流域属国、属部朝贡活动研究

辽朝在征服、招抚黑龙江流域乌古、敌烈、鼻骨德、五国部等族群之后,相继建立属国属部制度,并将其纳入王朝"道"一级行政区划之中,各属国属部在中央与地方的双重统辖下进行不同程度的朝贡活动。辽中期建立起管理属国、属部的地方机构,对一些属国属部的统辖机制开始由朝贡制度向行政统辖制度转变,表现出统辖关系紧密的乌古、敌烈部朝贡次数骤然减少,鼻骨德部次之,统辖关系相对疏松的五国部则实行持续而规律的朝贡活动,因此不可简单地认为黑龙江流域属国属部朝贡活动频繁是辽朝对其统辖紧密的体现。     

医疗事故法律责任的案例分析

近年来,医疗事故成为导致医患矛盾的主要因素,此类案件如不认真处理对待,极可能会引起群体性恶性事件。因此,对医疗纠纷案例不能赔钱了事,息事宁人。要深层次的考虑问题产生的根源,找出妥善解决此类问题的办法,才能减少该事件的再次发生。本文选取一起基层乡镇卫生院剖宫产母女双亡,查责任全在医方的案例进行解读。对此案例从医生的自身素质方面,包括业务水平以及医德素养方面进行评析,二是从医院管理制度方面进行漏洞剖析,三是从农村基层医院医资配置缺乏进行分析。从这三个导致此医疗事故的原因,提出要想减少这类事故频发,应大力加强卫生法的宣传教育,提高医务人员的法制、道德和业务素质,加强医疗机构的管理建设,从根本上杜绝此类事故的发生。     

ANSYS在TBM步进支撑台座设计中的应用

采用TBM全断面隧道掘进机施工,步进支撑台座的可靠性和经济性是保证工程顺利进行的前提。结合罗宾斯TBM步进方案,选用合理可靠的步进支撑台座,应用ANSYS软件建立有限元模型,以求在保证TBM安全通过的前提下,确定出混凝土标号、浇注量及是否需要配筋等内容来解决施工经济性与便捷性问题。