社区和医院感染性肺炎病原学及细菌药敏分析※

目的观察社区感染性肺炎（CAP）和医院感染性肺炎（HAP）的病原菌分布情况,并对细菌耐药性进行分析,以有效指导临床用药。方法对2011年11月至2012年9月住院收治的社区和医院感染性肺炎患儿痰标本进行病原检测的临床资料进行回顾性分析。结果 CAP病原菌以金黄色葡萄球菌为主,占53.66%,其次为大肠埃希菌37.25%;HAP病原菌以鲍氏不动杆菌和肺炎克雷伯菌杆菌为主,分别占47.50%和25.00%。结论临床医师应该熟练掌握抗菌药物适应症、用法用量、用药时机等,从而促进抗生素药物的合理应用,有效避免细菌耐药性的产生和加强。     

泸州地区鲍曼不动杆菌的分布和耐药性监测分析

目的了解泸州地区鲍曼不动杆菌的感染分布及耐药现状,为临床治疗提供依据。方法统计2010—2012年泸州地区5家综合性医院分离的鲍曼不动杆菌的来源、科室分布及药敏试验结果,应用WHONET5.4软件进行统计学分析。结果监测结果表明,检出率最高是痰(73.51%)和分泌物(10.08%),ICU和呼吸内科;头孢曲松、氨曲南、丁胺卡那霉素耐药率上升较快,超过了50%,差异有统计学意义;鲍曼不动杆菌对哌拉西林他唑巴坦钠、头孢哌酮钠舒巴坦钠、左氧氟沙星、环丙沙星和碳青霉烯类抗菌药物敏感率较高。结论泸州地区鲍曼不动杆菌耐药率有升高的趋势,应结合药敏试验结果选用抗菌药物。     

212例下呼吸道鲍曼不动杆菌感染分布与耐药性研究

目的探讨212例下呼吸道鲍曼不动杆菌感染分布表现、耐药性特点及多重耐药菌的易感因素。方法 2010年4月至2012年4月我院收治212例下呼吸道感染患者,对其分离出的212株鲍曼不动杆菌进行调查,分析其分布、耐药性及多重耐药性患者和非多重耐药性患者两者间的易感因素。结果 212例下呼吸道感染患者分离出鲍曼不动杆菌212株,其中多重耐药80株,主要分布在重症监护病房(ICU),其次为呼吸内科、神经内科等。2010-2012年多重耐药的鲍曼不动杆菌构成比例分别36.2%、36.7%、39.2%;其特点是对多粘菌素B最为敏感,其次是替加环素;对含有β-内酰胺酶抑制剂复方制剂抗菌类药物均表现为明显的耐药性。结论鲍曼不动杆菌对多粘菌素B最为敏感,其次是替加环素,对碳青霉素烯类抗菌药物其耐药性呈现逐步上升的趋势;使用不同抗菌药物、并发心脑血管疾病以及病情变化成为多重耐药菌感染的主要易感因素。     

内科重症监护病房耐药鲍曼不动杆菌流行病学分析

目的探讨内科重症监护病房(MICU)耐药鲍曼不动杆菌流行病学。方法收集2011年1月至2013年12月MICU送检的菌株标本637株,进行菌株分离鉴定及药敏试验,再行细菌菌谱及耐药性分析。结果 3年来分离出的鲍曼不动杆菌株占所有分离菌株总数的40.0%。除了替加环素,鲍曼不动杆菌几乎对所有抗生素的耐药率在70.0%以上,且有逐年增加的趋势;对碳青霉烯类耐药率达95.0%以上。结论 MICU鲍曼不动杆菌是主要流行病菌,其耐药率极高,除了鲍曼不动杆菌本身的属性外,还与交叉感染、消毒隔离及抗生素的应用有关。     

2018-2019年某三级医院抗菌药物用药频度与病原菌耐药率的相关性

目的分析某三级医院抗菌药物使用及病原菌分离情况,并进一步探究该院主要检出病原菌耐药率与抗菌药物用药频度(DDDs)的相关性。方法查询克拉玛依市人民医院医院信息系统(HIS),采用回顾性研究方法对2018—2019年全院临床病原菌分布情况、抗菌药物DDDs进行排名、汇总及分析。利用Pearson相关性分析考察该院主要检出病原菌耐药率与抗菌药物DDDs的相关性。结果该院2018—2019年分离的病原菌中,以革兰阴性菌为主,其中大肠埃希菌、肺炎克雷伯菌和流感嗜血杆菌排前3位。分离的革兰阳性菌以金黄色葡萄球菌和表皮葡萄球菌居多。金黄色葡萄球菌、大肠埃希菌和肺炎克雷伯菌分别检出甲氧西林、产超广谱β-内酰胺酶(ESBLs)等耐药株。抗菌药物DDDs排名前10位以β-内酰胺类为主,且β-内酰胺酶抑制剂复合制剂的DDDs呈明显上升趋势。Pearson相关性分析结果显示,金黄色葡萄球菌耐药率与青霉素、红霉素的DDDs正相关(P<0.05);大肠埃希菌耐药率与头孢呋辛的DDDs正相关(P<0.05),与头孢哌酮舒巴坦、哌拉西林钠他唑巴坦的DDDs负相关(P<0.05);肺炎克雷伯菌耐药率与头孢哌酮舒巴坦、哌拉西林钠他唑巴坦的DDDs负相关(P<0.05)。结论该院抗菌药物使用情况基本合理,但临床上革兰阴性菌产ESBLs较为严重,建议选择与抗菌药物DDDs负相关的药物治疗,同时加强监管,以减少细菌耐药现象发生。     

新生儿呼吸机相关性肺炎病原菌调查及药敏分析

目的探讨新生儿呼吸机相关性肺炎(VAP)的发病率、高危因素、病原学特点、耐药性及预防措施,为新生儿VAP的防治提供一定的理论依据。方法选取我院新生儿病房自2009年1月至2012年1月所收治的64例VAP新生儿作为研究对象,药敏质量监控采用金黄色葡萄球菌(ATCC 25923)、大肠埃希氏菌(ATCC 25922)、质控菌株铜绿假单胞菌(ATCC 27853)进行。结果 64例新生儿标本检出病原菌36株,阳性率56.2%,病原菌前5位从后到前为嗜麦芽窄食假单胞菌、溶血葡萄球菌、大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌;5例(13.9%)真菌,7例(19.4%)革兰阳性菌,24例(66.7%)革兰阴性菌。结论临床上以革兰阴性菌最常见,为了大幅度降低多重耐药菌和混合感染的发生,应努力做到早治疗、早预防,并及时监测。     

重症监护病房内感染病原菌及耐药性分析

目的探讨重症监护病房(ICU)内感染病原菌及耐药性。方法选取我院2013年1月至2014年1月所收治的107例下呼吸道感染患者,所有菌株都来自于本组107例患者,菌株鉴定基于常规痰细菌进行培养。采用(NCCLS)判断标准、K-B纸片扩散法及血平板培养。结果本组患者中共分离出致病菌92株,其中17株(18.5%)为真菌,以白色念珠菌为主;32株(34.8%)为革兰阳性菌,以肺炎链球菌、表皮葡萄球菌和金黄色葡萄球菌为主;43株(46.7%)为革兰阴性菌,以阴沟肠杆菌、大肠埃希菌、不动杆菌、铜绿假单胞菌为主。结论为了降低ICU室内感染病原菌含量,应该加强ICU的器械消毒和环境保洁,严格探视制度,特别是要加强吸痰管、冷凝水、呼吸管路的管理,以便能够有效地控制院内感染。     

复发性尿路感染的细菌检验和药敏情况及治疗研究

目的研究复发性尿路感染的细菌检验和药敏情况,找出相应的治疗措施。方法将我院在2012年9月至2013年9月收治的70例复发性尿路感染患者作为研究对象,对其做尿液细菌培养和药敏试验,根据试验结果分期应用长期疗程治疗方法。结果 70例患者中有25例的尿细菌检验呈阳性,占35.7%,其中20例为大肠埃希菌,3例为粪肠球菌,2例为肺炎克雷伯菌,4例合并支原体感染;经治疗总有效率为97.1%。结论在复发性尿路感染的临床治疗中,仅依靠尿细菌检验指导长期疗程治疗局限性较大,有必要根据药敏试验结果选用抗生素,结合分期疗法,以提高临床疗效。     

尿液培养病原菌的分布及耐药性分析

目的对泌尿系感染病原菌的分布及其耐药性等情况进行分析与探讨,为临床合理的应用抗生素提供重要的依据。方法对本医院自2009年3月～2011年10月之间住院及门诊患者尿培养阳性319例细菌资料进行回顾性总结与分析。结果 12例尿液细菌培养分离出172株细菌分布,其中细菌类型主要有大肠埃希菌、肠球菌,分别占到48.9%,肠球菌占14.2%。肠球菌属对环丙沙星、利福平、庆大霉素具有较高的耐药率,达到60%以上,大肠埃希菌的耐药性则主要体现在哌拉西林、环丙沙星、氧氟沙星上。对头孢类具有敏感性,但不太明显。结论在临床治疗过程中应该根据尿液培养病原菌的分布以及耐药性变化,合理的选择和科学的使用抗生素,以保证更加有效地遏制耐药菌的生长。     

喹诺酮类抗菌药物耐药性研究

目的研究住院患者临床标本分离出来的病原菌对环丙沙星、左氧氟沙星两类喹诺酮类抗菌药物的耐药性。方法选取2012年2月～2013年2月于我院住院患者临床标本中分离出来的病原菌1500株。选取型号为Vitek2的全自动微生物鉴定仪来鉴定病原菌种类,同时利用喹诺酮类抗菌药物进行敏感性检测。结果1500株病原菌中分离出587株革兰氏阳性菌（39.1%）,包括238株金黄色葡萄球菌、109例溶血葡萄球菌,而表皮葡萄球菌和粪肠球菌的数量分别为88株、85株,剩余67株为屎肠球菌;共有革兰氏阴性菌913株（60.9%）,包括293株大肠埃希斯菌、225株铜绿假单胞菌,而肺炎克雷伯菌和阴沟肠杆菌的数量分别为139株、93株,嗜麦芽窄食单胞菌和鲍曼氏不动杆菌分别有80株、65株,剩余18株为洋葱伯霍尔德菌。溶血葡萄球菌对喹诺酮类药物环丙沙星和左氧氟沙星的耐药性最强,屎肠球菌、金黄色葡萄球菌和表皮葡萄球菌耐药性均超过50%,唯独粪肠球菌耐药性偏低。大肠埃希氏菌对喹诺酮类药物的耐药性最强,而嗜麦芽窄食单胞菌对环丙沙星和左氧氟沙星的耐药性分别为67.7%、15.6%,出现两极分化的现象,其余几类革兰氏阴性菌耐药性均低于50%。结论为了改善病原菌对喹诺酮类抗菌药物的耐药情况,通过联合和合理用药来降低出现耐药株的概率至关重要。     

Pleasure and belief in Hume's Decision Process

Abstract

The purpose of this paper is to introduce explicitly pleasure and belief in what aims at being a Humean theory of decision, like the one developed in Diaye and Lapidus (2005a). Although we support the idea that Hume was in some way a hedonist – evidently different from Bentham's or Jevons' way – we lay emphasis less on continuity than on the specific kind of hedonism encountered in Hume's writings (chiefly the Treatise, the second Enquiry, the Dissertation, or some of his Essays). Such hedonism clearly contrasts to its standard modern inheritance, expressed by the relation between preferences and utility.

The reason for such a difference with the usual approach lies in the mental process that Hume puts to the fore in order to explain the way pleasure determines desires and volition. Whereas pleasure is primarily, in Hume's words, an impression of sensation, it takes place in the birth of passions as reflecting an idea of pleasure, whose “force and vivacity” is precisely a “belief”, transferred to the direct passions of desire or volition that come immediately before action. As a result, from a Humean point of view, “belief” deals with decision under risk or uncertainty, as well as with intertemporal decision and indiscrimination problems.

The latter are explored within a formal framework, and it is shown that the relation of pleasure is transformed by belief into a non-empty class of relations of desire, among which at least one is a preorder.     

Globalization,Neoliberalism and the attack on social security

Neoliberal political movements advocate privatization of public pension systems. Globalization imposes pressure on nations to conform to neoliberal policy views with respect to the design and structure of social insurance, including public pension systems. The paper begins with an investigation of the economic, ethical and ideological dimensions of the privatization debates in the U.S.; it argues that privatization advocates may be largely moved by ideology, since the other reasons advanced appear weak or unfounded. The second part discusses the history of Social Security, the purposes for its creation, and some of its economic effects. Differences between public and private pension systems are considered. A brief international comparison of some aspects of public pension system finance and benefit structures is presented. The final section considers the ethical, macroeconomic and distributional implications of privatization, prefunding and payroll tax funding, and argues for a pay as you go system financed with income taxes. In order to promote equity, economic security, community, and social cohesion, public pension systems should be universal in coverage. In order to reduce the inequality, income insecurity, and aged poverty generated by market economies, public pension systems ought to be progressive: benefit/contribution ratios should be inversely proportional to income, and progressive income taxes should finance the system. To promote economic growth, the systems should be financed on a pay-as-you-go basis, and should not be prefunded except for an emergency reserve. The fiscal policy recommendations partially depend upon the theory developed by Abba Lerner in the 1940s, and recently advanced by Wynne Godley and Randy Wray: Lerner's “principle of functional finance.”     

Interest on reserves and inflation

The payment of interest on reserves has been a common practice in inflationary economies. This policy may seem paradoxical since it involves returning part of the seigniorage, generated by the inflation process, with the intention to finance the fiscal deficit. This paper argues that the motivation for this policy can be captured by the discretionary regime, where the policymaker pays interest on reserves because he is concerned with the erosion of real liquidity by inflation, which is in part beyond his control. However, this policy is an unlikely outcome in the commitment regime, where the policymaker is in full control of inflation.     

Bayesian estimation of duration models: An application of the multiperiod probit model

The multiperiod probit model is presented and Bayesian estimation using the Gibbs sampler with data augmentation is described. As an empirical illustration, the multiperiod probit model is then used to estimate a duration model using employment duration data for the Canadian province of New Brunswick. Bayesian estimation with unobserved heterogeneity is shown to be a simple extension of estimation of a duration model with no unobserved heterogeneity. More importantly, perhaps, some numerical problems encountered by other authors using Maximum Likelihood are avoided.I would like to thank M. Baker, G. Koop, A. Melino and D. Poirier for helpful comments and discussions. I would also like to thank M. Baker for providing his data.     

Scenarios and creativity: Thinking in new boxes

To be creative and make change happen, leaders must do more than simply ‘think outside the box’, as the traditional business manuals suggest, using the popular American expression. After all, the space outside the box is infinitely expansive. Moreover, there can be no guarantee that a solution to the problem will be found. The answer: ‘Think in new boxes.’ This requires developing the right new box; in other words, useful new models, a helpful new approach to a problem. That is the real art of practical creativity. This short article outlines the approach (Thinking in New Boxes) and its application to classic scenario planning with a few examples. The authors also present the ‘Expressway to Scenarios’, an approach that wins in impact and practicality what it loses in deep analysis, by having top executives involved in key steps.     

Forecasting the price of gold

This article seeks to evaluate the appropriateness of a variety of existing forecasting techniques (17 methods) at providing accurate and statistically significant forecasts for gold price. We report the results from the nine most competitive techniques. Special consideration is given to the ability of these techniques to provide forecasts which outperforms the random walk (RW) as we noticed that certain multivariate models (which included prices of silver, platinum, palladium and rhodium, besides gold) were also unable to outperform the RW in this case. Interestingly, the results show that none of the forecasting techniques are able to outperform the RW at horizons of 1 and 9 steps ahead, and on average, the exponential smoothing model is seen providing the best forecasts in terms of the lowest root mean squared error over the 24-month forecasting horizons. Moreover, we find that the univariate models used in this article are able to outperform the Bayesian autoregression and Bayesian vector autoregressive models, with exponential smoothing reporting statistically significant results in comparison with the former models, and classical autoregressive and the vector autoregressive models in most cases.     

How chaebol restructuring after the 1997 crisis has affected corporate decision and performance in Korea: debt financing,ownership structure,and investment

ABSTRACT

Korean chaebol firms, characterized by excessive debt financing and overinvestment, experienced restructuring after the 1997 crisis. By reducing debt financing and thus overinvestment, they tried to reorganize financing structure and ownership structure. Chaebols’ debt reduction turns out to have improved performance. However, polarization between chaebol and non-chaebol firms has become more significant. Even after the crisis, firms that give higher cash flows to a controlling shareholder take more capital investment, indicating that agency problems still exist within chaebols. Chaebol-affiliated firms continue to be more active in R&D than non-chaebol firms. However, the pattern is limited to the group of top 10 chaebols after the crisis.

Abbreviations: KFTC: Korea Fair Trade Commission     

On the Role of Paradigms in Understanding Economic Globalization

Any adequate analysis of economic globalization necessarily requires fundamental understanding of the worldviews underlying the views expressed with respect to the nature and role of economic globalization. This paper is based on the premise that any worldview can be associated with one of the four basic paradigms: functionalist, interpretive, radical humanist, and radical structuralist. It argues that any view expressed with respect to economic globalization is based on one of the four paradigms or worldviews. It, therefore, discusses four views with respect to the nature and role of economic globalization which correspond to the four broad worldviews. The paper emphasizes that the four views expressed are equally scientific and informative; they look at the nature and role of economic globalization from a certain paradigmatic viewpoint. Emphasizing this example in the area of economic globalization, the paper concludes that there are opportunities for each paradigm to benefit from contributions coming from the other three paradigms.     

A Humean theory of choice of which rationality may be one consequence

For the reader who considers economic theory of choice as a special case of a more general theory of action, Hume's discussion of the determinants of action in the Treatise of Human Nature (1739?–?40), in the Enquiry on Human Understanding (1748) and in the Dissertation on Passions (1757) deserves attention. However, according to some modern commentators, Hume does not seem to have given any evidence that would favour what nowadays we would consider as the kind of rationality involved in modern theories of rational choice. On the contrary, this paper arrives at the conclusion that consistency between preferences and choice, like the usual properties of completeness and transitivity, may be considered as outcomes of a mental process, described by means of a decision algorithm that aims to represent Hume's theory of choice.     

The concept of freedom and its relation to economic development--a critical appreciation of the work of Amartya Sen

Following a brief review of the conception of freedom as employedin economic discourse, this paper focuses on the evolution ofthe concept of freedom in the work of Amartya Sen. It tracesthe development of Sen's thought from the capability analysisof the late 1970s to his more recent separation of freedom intoits opportunity and process aspects. While broadly appreciativeof Sen's development of the concept of positive freedom, thepaper identifies some difficulties arising from his definitionof capability as a set of options as well as from his separationof the opportunity and process aspects of freedom. Aspects ofthe relationship between Sen's conception of freedom and thatof Marx are discussed briefly in the context of Sen's recentdiscussion of the market as a source of freedom.