Adherence to three different strategies to prevent early onset GBS infection in newborns

ProblemDespite the introduction of preventive guidelines, no decrease in the incidence of early onset infection was observed.BackgroundEarly onset group B streptococcal (EOGBS) infection is an important cause of neonatal morbidity and mortality.AimOur study was conducted to determine adherence to three guideline-based group B streptococcus (GBS) preventive strategies.MethodsA prospective experimental study clustered by obstetric collaboration region was performed between March 2013 and August 2014 among midwives, obstetricians and paediatricians in the Netherlands. At baseline, the three regions operated according to the Dutch preventive strategy (founded on the risk-based strategy) in order to prevent EOGBS infection, whereas in the study period they followed either the risk-based, the combination or the Dutch strategy. Adherence was measured prospectively per pregnant woman, using predefined core elements of each preventive strategy: identification of risk factors, maternal GBS screening, application of intrapartum antibiotic prophylaxis and observation of the child. Data about adherence to the core elements were collected from medical records, maternal questionnaires and laboratory test results.FindingsIn the three regions, a total of 121 care providers and 1562 women participated.We found an overall adherence of 90% to the risk-based strategy, 57% to the combination strategy and 89% to the Dutch strategy. Adherence to a strategy in case women had EOGBS risk factors was below 20% in all strategies.DiscussionThe majority of women with EOGBS risk factors did not receive the care prescribed by any of three preventive strategies and were not treated optimally.ConclusionThe risk-based and the Dutch strategy are the recommended strategies for implementation.     

以习近平总书记“3·18”讲话为重要遵循 推进新时代思政课建设

习近平总书记在2019年3月18日主持召开全国学校思想政治理论座谈会并发表重要讲话，即“3·18”讲话。在“3·18”讲 话中，习近平总书记不仅强调了新时代我们“为什么”要办好思想政治理论课，而且明确回答了新时代我们要办“什么样”的思 想政治理论课和“如何办好”思想政治理论课等一系列重大问题。实践表明， “3·18”讲话是党中央新时代办好思想政治理论课 的重要遵循。在该讲话发表一周年之际，重温这一讲话具有重要理论和现实意义。     

Isoniazid Completion Rates for Latent Tuberculosis Infection Among College Students Managed by a Community Pharmacist

Objective: The authors' objective was to document 9-month and previously recommended 6-month treatment completion rates for latent tuberculosis infection (LTBI) in a pharmacistmanaged LTBI clinic in a community pharmacy on a college campus, and to describe patient characteristics. Participants: Participants were university students diagnosed with LTBI. Methods: The authors conducted a retrospective review of pharmacy records from 2000 to 2006. Main outcome measures included 6-month and 9-month LTBI treatment completion rates, total isoniazid (INH) tablets taken, characteristics of completers versus noncompleters, average time to treatment completion, and reported adverse drug events. Results: The 9-month completion rate was 59%, and the 6-month completion rate was 67%. Among those not completing treatment, 15.2% experienced fatigue and 2.2% experienced a rash (p = .04 and p = .03, respectively). Conclusion: LTBI clinics are a unique niche for community pharmacies and can provide individualized patient care to ensure LTBI treatment adherence, monitoring for disease progression, and safety of INH.     

Accommodating stochastic departures from percentile invariance in causal models

Summary.  Consider a clinical trial in which participants are randomized to a single-dose treatment or a placebo control and assume that the adherence level is accurately recorded. If the treatment is effective, then good adherers in the treatment group should do better than poor ad- herers because they received more drug; the treatment group data follow a dose–response curve. But, good adherers to the placebo often do better than poor adherers, so the observed adherence–response in the treatment group cannot be completely attributed to the treatment. Efron and Feldman proposed an adjustment to the observed adherence–response in the treatment group by using the adherence–response in the control group. It relies on a percentile invariance assumption under which each participant's adherence percentile within their assigned treatment group does not depend on the assigned group (active drug or placebo). The Efron and Feldman approach is valid under percentile invariance, but not necessarily under departures from it. We propose an analysis based on a generalization of percentile invariance that allows adherence percentiles to be stochastically permuted across treatment groups, using a broad class of stochastic permutation models. We show that approximate maximum likelihood estimates of the underlying dose–response curve perform well when the stochastic permutation process is correctly specified and are quite robust to model misspecification.     

农村2型糖尿病患者治疗依从性及影响因素分析

通过自行设计调查问卷,采用多阶段随机抽样方法对江苏省两地区农村2型糖尿病患者进行调查,了解农村2型糖尿病患者治疗依从性的现状,探明影响患者治疗依从性的因素,为完善有关对策提供依据?结果显示,90.6%的2型糖尿病患者服药依从性好?确诊年限?随访次数?疾病知识知晓程序等对农村2型糖尿病患者服药依从性的影响差异有统计学意义(P<0.05);57.9%的患者非药物治疗依从性较好,但在体育锻炼?戒烟限酒方面仍需加强?应加强各级医疗机构之间的配合,开展有针对性的知识宣教,提高患者自身的健康信念与自我管理意识,以进一步提高患者的治疗依从性?     

戴震:前清学术之集大成者

戴震是前清学术集大成者。他继承明清之际思想家们反对理学的传统,对程朱理学“以理杀人”虚伪残忍的本质进行了激烈的抨击。他对清儒的繁琐考据,宋儒的凭己臆说和汉儒的墨守家法均有所批判,坚持“空所依傍,唯求其是”的学术主张,为中国文化思想史作出了卓越的贡献。     

Development of a Standard Soil-to-Skin Adherence Probability Density Function for Use in Monte Carlo Analyses of Dermal Exposure

It has recently been suggested that "standard" data distributions for key exposure variables should be developed wherever appropriate for use in probabilistic or "Monte Carlo" exposure analyses. Soil-on-skin adherence estimates represent an ideal candidate for development of a standard data distribution: There are several readily available studies which offer a consistent pattern of reported results, and more importantly, soil adherence to skin is likely to vary little from site-to-site. In this paper, we thoroughly review each of the published soil adherence studies with respect to study design, sampling, and analytical methods, and level of confidence in the reported results. Based on these studies, probability density functions (PDF) of soil adherence values were examined for different age groups and different sampling techniques. The soil adherence PDF developed from adult data was found to resemble closely the soil adherence PDF based on child data in terms of both central tendency (mean = 0.49 and 0.63 mg-soil/cm²-skin, respectively) and 95th percentile values (1.6 and 2.4 mg-soil/cm²-skin, respectively). Accordingly, a single, "standard" PDF is presented based on all data collected for all age groups. This standard PDF is lognormally distributed; the arithmetic mean and standard deviation are 0.52 ± 0.9 mg-soil/cm²-skin. Since our review of the literature indicates that soil adherence under environmental conditions will be minimally influenced by age, sex, soil type, or particle size, this PDF should be considered applicable to all settings. The 50th and 95th percentile values of the standard PDF (0.25 and 1.7 mg-soil/cm²-skin, respectively) are very similar to recent U.S. EPA estimates of "average" and "upper-bound" soil adherence (0.2 and 1.0 mg-soil/cm²-skin, respectively).     

王学与庄学关系初探

文章通过对王阳明心学体系的三个组成部分的考察,认为王阳明在建立心学体系时全面继承了庄学中的精华,以改造程朱理学体系。