论“病”细穷源

张太医论病细穷源,写的是秦可卿心理焦虑、抑郁,精神崩溃的事实;因为贾珍爬灰,致使秦可卿完全陷入被动,一旦被尤氏撞破,便落得个＂画梁春尽落香尘＂的悲剧结局。细穷病源的目的,揭露封建贵族大家庭的腐败,其本身就是罪恶的渊薮;贾珍是罪孽的主凶,秦可卿本来无罪却变成替罪的羔羊,终于在大出殡的歌唱声中,掩盖了贾氏家族的所有罪恶。     

Inference for Epidemics with Three Levels of Mixing: Methodology and Application to a Measles Outbreak

Abstract. A stochastic epidemic model is defined in which each individual belongs to a household, a secondary grouping (typically school or workplace) and also the community as a whole. Moreover, infectious contacts take place in these three settings according to potentially different rates. For this model, we consider how different kinds of data can be used to estimate the infection rate parameters with a view to understanding what can and cannot be inferred. Among other things we find that temporal data can be of considerable inferential benefit compared with final size data, that the degree of heterogeneity in the data can have a considerable effect on inference for non‐household transmission, and that inferences can be materially different from those obtained from a model with only two levels of mixing. We illustrate our findings by analysing a highly detailed dataset concerning a measles outbreak in Hagelloch, Germany.     

Testing for qualitative interaction of multiple sources of informative dropout in longitudinal data

Longitudinal studies suffer from patient dropout. The dropout process may be informative if there exists an association between dropout patterns and the rate of change in the response over time. Multiple patterns are plausible in that different causes of dropout might contribute to different patterns. These multiple patterns can be dichotomized into two groups: quantitative and qualitative interaction. Quantitative interaction indicates that each of the multiple sources is biasing the estimate of the rate of change in the same direction, although with differing magnitudes. Alternatively, qualitative interaction results in the multiple sources biasing the estimate of the rate of change in opposing directions. Qualitative interaction is of special concern, since it is less likely to be detected by conventional methods and can lead to highly misleading slope estimates. We explore a test for qualitative interaction based on simultaneous confidence intervals. The test accommodates the realistic situation where reasons for dropout are not fully understood, or even entirely unknown. It allows for an additional level of clustering among participating subjects. We apply these methods to a study exploring tumor growth rates in mice as well as a longitudinal study exploring rates of change in cognitive functioning for Alzheimer's patients.     

中国居民健康对劳动参与的影响——基于多维健康指标的实证分析

居民健康对劳动参与的影响至关重要。国内相关研究只使用了自我评价的一般健康状况来衡量健康水平,然而健康是多维的,该指标可能未能全面度量我国居民真实健康水平对劳动参与的影响。为了克服这个问题,本文还同时使用短期疾病冲击、疾病史、身体质量指数、营养摄入等多个健康指标。结果表明,自我评价的一般健康状况没能完全揭示我国居民真实健康水平对劳动参与的影响,包括其在内的各个健康指标均为此可以提供相对独立的信息。      

Rate of Foot-and-Mouth Disease Virus Transmission by Carriers Quantified from Experimental Data

Upon infection with foot-and-mouth disease virus (FMDV) a considerable number of animals become carriers of the virus. These carriers are considered to be a risk for new outbreaks, but the rate at which these animals can transmit the infection has not been quantified. An analysis was carried out using data from previously published experiments in order to quantify the transmission rate parameter β of FMDV infection from carriers to susceptible animals. The parameter β was estimated at 0.0256 (likelihood-based confidence interval: 0.008–0.059) infections per carrier per month. Moreover, analysis of published experimental data indicates that the proportion of FMDV carriers decreases at a rate of 0.115 per month. Both parameters obtained from this study are useful for quantitative risk analyses of the trade of animals from FMDV-infected areas or the lifting of vaccination programs.     

Bayesian hierarchical joint modeling using skew-normal/independent distributions

The multiple longitudinal outcomes collected in many clinical trials are often analyzed by multilevel item response theory (MLIRT) models. The normality assumption for the continuous outcomes in the MLIRT models can be violated due to skewness and/or outliers. Moreover, patients’ follow-up may be stopped by some terminal events (e.g., death or dropout), which are dependent on the multiple longitudinal outcomes. We proposed a joint modeling framework based on the MLIRT model to account for three data features: skewness, outliers, and dependent censoring. Our method development was motivated by a clinical study for Parkinson’s disease.     

A perfect storm: Challenges encountered by family caregivers of persons with Alzheimer’s disease during natural disasters

ABSTRACT

Since Hurricane Katrina there has been a movement across the U.S. to examine best practice for disaster response within the aging population. However, little is known about the experience of natural disasters from the perspective of family caregivers of persons with Alzheimer’s disease and related dementia (ADRD). In this exploratory, qualitative study, family caregivers (n=27) were interviewed about their experience with the historic 2015 South Carolina flood. By using thematic analysis, themes were identified to better understand what unique challenges caregivers of person with ADRD experienced. While many caregivers stated they had experienced a natural disaster previously, none had ever done so in their current caregiving role. The caregiving role affected their ability to prepare for the storm and influenced their decision-making regarding evacuation and utilization of recovery resources. Thus, caregivers were confronted by a “perfect storm” of circumstances and uncertainty. Family caregivers need to have actionable emergency plans for disasters that are specific to their role as caregivers of persons with ADRD. Study implications also suggest the role social work professionals can have in educating, advocating, evaluating, and coordinating support to assist caregivers of persons with ADRD as a potentially vulnerable and at-risk population during all phases of disaster.     

The Patient Profile Pharmacy Filing System

Abstract

“Herpes Simplex Virus Proctitis in Homosexual Men: Clinical, Sigmoidoscopic, and Histopathological Features,” Steven E. Goodell, Thomas C. Quinn, Emmanuel Mkrtichian, Michael D. Schuffler, King K. Holmes, and Lawrence Corey. Acute herpes simplex virus (HSV) infection was detected in 23 of 102 consecutively examined, sexually active male homosexuals who presented with anorectal pain, discharge, tenesmus, or hematochezia, as compared with 3 of 75 homosexual men without gastrointestinal symptoms (P < 0.01). Findings that were significantly more frequent in men with HSV proctitis than in men with proctitis due to other infectious causes included fever (48 per cent), difficulty urinating (48 per cent), sacral paresthesias (26 per cent), inguinal lymphadenopathy (57 per cent), severe anorectal pain (100 per cent), tenesmus (100 per cent), constipation (78 per cent), perianal ulcerations (70 per cent), and the presence of diffuse ulcerative or discrete vesicular or pustular lesions in the distal 5 cm of the rectum (50 per cent). Serologic evidence indicated that 85 per cent of the men with symptomatic HSV proctitis were having their first episode of HSV-2 infection. The diagnosis of HSV proctitis is suggested by the presence of severe anorectal pain, and diffuse ulceration of the distal rectal mucosa. (New England Journal of Medicine 1983;308:868–71.)     

The Boric Acid Powder Treatment of Vulvovaginal Candidiasis

Abstract

This double blind comparison of fourteen daily intravaginal gelatin capsules containing 600 mg of boric acid powder versus identical capsules containing 100,000 units of nystatin diluted to volume with cornstarch found vulvovaginal candidiasis albicans cure rates for boric acid to be 92% seven to ten days after treatment and 72% at thirty days, whereas the nystatin cure rates were 64% at seven to ten days and 53% at thirty days. Speed of alleviation of signs and sumptoms was similar with both drugs. There were no untoward side effects, and cervical cytology was not affected. In vitro studies found boric acid to be fungistatic and its effectiveness to be unrelated to pH. Blood boron analyses indicated little absorption from the vagina and a half life of less than 12 hours. A 30% follow-up of 2,030 nonstudy patients revealed wet mount and symptom cure rates of 93% within two weeks and 88% within four weeks. Patient acceptance was better than with “messy” vaginal creams, and self-made boric acid powder capsules are inexpensive, 31¢ for fourteen, compared with costly, commonly prescribed medication.     

Results of a Heart Disease Risk-Factor Screening Among Traditional College Students

Abstract

Biological, behavioral, and psychosocial contributions to the gender gap in coronary heart disease (CHD) are discussed. Although CHD is the Number 1 cause of death for both sexes in the industrialized world, CHD mortality rates between these countries are larger than those between men and women, suggesting that biological factors are not the sole influences on the gender gap in CHD. Traditional coronary risk factors cannot explain the rapid increase in CHD mortality among middle-aged men in many of the newly independent states of eastern Europe. However, eastern European men score higher on stress-related psychosocial coronary risk factors (eg, social isolation, vital exhaustion) than men living in the West. Comparisons between the sexes also reveal gender differences in psychosocial and behavioral coronary risk factors, including excessive alcohol consumption and smoking, favoring women. Overall, it appears that men's coping with stressful events may be less adaptive physiologically, behaviorally, and emotionally, contributing to their increased risk for CHD.