纵欲与禁欲——海派小说研究

纵欲与禁欲是性爱生活中通向死亡的两条路径.张资平小说中的人物一方面沉溺在纵欲的享乐中,另一方面又摆脱不了死本能的威胁;身体意象在穆时英和张爱玲的小说里作无生命的比喻;《塔里的女人》中不食人间烟火式的恋爱,最终走向了失败与死亡;许多研究者喜欢从佛欲冲突的角度解析叶灵凤的《昙华庵的春风》,这篇小说其实讲的不是一个佛欲冲突的故事,而是一个少女怀春的故事.     

论徽州文化对吴组缃小说创作的影响

徽州文化对吴组缃及其小说的创作观念、思想内涵、艺术个性等方面产生了直接或间接的影响,特殊的地域文化丰富和深化了作家的创作个性。     

Time-driven activity-based cost analysis for outpatient anticoagulation therapy: direct costs in a primary care setting with optimal performance

Objectives: To determine how overall cost of anticoagulation therapy for warfarin compares with that of Novel Oral Anticoagulants (NOACs). Also, to demonstrate a scientific, comprehensive, and an analytical approach to estimate direct costs involved in monitoring and management of anticoagulation therapy for outpatients in an academic primary care clinic setting, post-initiation of therapy.

Methods: A population-based cross-sectional study was conducted in conjunction with observations of patient care processes between August 2014 and January 2015. The study was conducted in an academic primary care outpatient setting at Mayo Clinic’s warfarin anticoagulation clinic, Rochester, MN. The anticoagulation clinic serves patients 18?years of age or older in Warfarin therapy management, for any indication, after referral from the patient’s primary care provider. The study included anticoagulation clinic enrollment data on a population of 5,526 patients. Time-Driven Activity-Based Costing (TDABC) technique was applied. Detailed process flow maps which showed process steps for all the anticoagulation program components and care continuum phases were created. Staff roles associated with each of the process steps were identified and displayed on the maps. Process times and costs were captured and analyzed. The main outcome was direct cost of monitoring and management of anticoagulation therapy, post-initiation of therapy.

Results: The cost of warfarin management for patients who display unstable International Normalized Ratio (INR) is more than three times those who display stable INR over time. (Comparator to distinguish stability: Frequency of point-of-care visits needed by patients.) For complex anticoagulation patients, total cost of medication and monitoring for warfarin anticoagulation therapy is similar to that for NOACs.

Conclusion: Despite warfarin being significantly less expensive to purchase than NOACs, overall warfarin management incurs higher costs due to laboratory monitoring and provider time than NOACs. NOAC treatment, therefore, may not be more expensive than warfarin therapy management for complex anticoagulation patients.     

Consumer versus Expert Hazard Identification: A Mental Models Study of Mutation‐bred Rice

Novel foods have been the object of intense public debate in recent years. Despite efforts to communicate the outcomes of risk assessments to consumers, public confidence in the management of potential risks has been low. Various reasons behind this have been identified, chiefly a disagreement between technical experts and consumers over the nature of the hazards on which risk assessments should focus, and perceptions of insufficient openness about uncertainties in risk assessment. Whilst previous research has almost exclusively focused on genetically modified foods, the present paper investigates plant varieties developed by means of mutation breeding, a less‐debated class of novel foods. Two studies were conducted that investigated the mental models of experts and laypeople. The results revealed that the mental models of both groups differed in terms of scope, depth and the role of uncertainty. Furthermore, a number of misconceptions became apparent in the study of laypeople's mental models, often related to the regulatory system governing risk assessments of novel foods. Critical issue are outlined and communication needs are discussed.     

分析新生儿感染性肺炎的诊断与治疗

目的探讨分析新生儿感染性肺炎的诊断和有效治疗方法。方法对我院在2009年3月-2011年3月间收治的102例新生儿感染性肺炎患者临床资料进行回顾性分析,总结分析新生儿感染性肺炎的诊断和治疗方法。结果经过治疗后102例患者中有显效71例,有效23例,无效为8例,总有效率达到92.2%。结论新生儿感染性肺炎临床表现多样,经过以抗感染为主的治疗后,临床疗效明显,值得在临床上推广。     

Impact of novel agents on patient-relevant outcomes in patients with previously untreated chronic lymphocytic leukemia who are not eligible for fludarabine-based therapy

Background: Chronic lymphocytic leukemia (CLL) is an orphan disease that primarily affects the elderly. The majority of symptomatic patients eligible for frontline treatment are unfit for fludarabine based chemoimmunotherapy. Historical treatment includes chlorambucil (Chl), bendamustine/rituximab (BR), and chlorambucil/rituximab/ChlR combination. Clinical guidelines now recommend the use of novel agents, such as ibrutinib (Ibr), in both frontline and relapse settings and other novel agents, such as idelalisib (with rituximab), in relapse settings. Despite compelling clinical results for novel agents, follow-up in clinical trials is relatively short and, thus, the comparative long-term benefits are still unknown.

Materials and methods: The authors developed a simulation model to generate treatment specific lifetime estimates of Overall Survival (OS) and Quality Adjusted Life Years (QALYs) for treatment with BR, Chl, ChlR, and Ibr. Two potential clinical scenarios were modelled: with and without novel agents for treating CLL. The model was based on health states relating to first- and second-line progression-free survival (PFS), post-progression survival, and death.

Results: Where novel agents were assumed unavailable, mean OS ranged from 5.4–8.5 years and QALYs from 3.5–6.1. Where novel agents were available, the mean OS increased to 10.0 years, with a corresponding increase in QALYs to 7.6. Frontline Ibr use followed by Physician’s Choice, including novel agents at relapse, resulted in projected increase in OS of between 18% (1.5 years) and 85% (4.6 years), corresponding to a 25–117% increase in QALYs, compared with currently available traditional therapies.

Limitations: The limitations of this analysis include immature OS data and the assumption of equivalent efficacy across all novel agents in terms of their impact on PFS and OS.

Conclusions: The use of novel agents is predicted to yield substantive gains in predicted lifetime OS and QALY improvements compared to traditional therapies in CLL patients who are ineligible for fludarabine-based chemoimmunotherapy.     

基于新冠肺炎疫情后三亚旅游业高质量发展的研究

随着新型冠状肺炎疫情在全国各地蔓延,给国内的旅游业造成巨大的冲击.借此,文章从新冠肺炎疫情对三亚旅游业产生的影响进行研究,依据《三亚市有效应对疫情支持旅游企业发展十条政策措施》(三府办〔2020〕19号)的通知,同时,借鉴2003年非典时期,张家界应对疫情成功有效的措施,有针对性地提出发挥以政府为主导的策略和以涉旅企业...     

亦真亦幻的错综世界——白先勇小说《游园惊梦》新探

关于白先勇的小说《游园惊梦》,前人评论已经不少,著名的评论家有欧阳子、隐地、刘俊等,脱口而出的有悲天悯人的情怀、传统文化的眷恋、王谢堂前燕的今昔之感等等,这篇文章是在前人评论的基础上,通过文本细读的方法,从新的角度探索其艺术特点,探索作者的用意。     

多层螺旋CT薄层图像与多平面重组图像在真菌性肺炎患者诊断中的应用价值

目的：探讨多层螺旋CT薄层图像与多平面重组（MPR）图像在真菌性肺炎患者诊断中的应用价值。方法选取河南省郑州市中医院肺病科接受治疗的50例真菌性肺炎患者，分别采用多层螺旋CT薄层图像与MPR图像方法进行诊断，分析两种检测方法各种征象的显示结果情况及各种真菌感染病变的累及情况。结果采用两种方法进行检测后，白色念珠菌、放线菌以及曲菌3种细菌感染肺部的累及情况比较，差异无统计学意义（P＞0.05）。分别采用两种方法对50例真菌性肺炎患者进行检测后，MIR图像各种征象的显示结果明显高于多层螺旋CT薄层图像的各种征象的显示结果，差异统计有学意义（P＜0.05）。结论多层螺旋CT薄层图像与MPR图像在诊断真菌性肺炎中的临床价值明显，而MPR图像的检测结果更为准确，但同时联合应用两种方法更能有效对病变的情况进行检测。     

A cost-minimisation analysis comparing different antibiotic regimens used in treating all-cause bacterial pneumonia in Hong Kong

Abstract

Background: To find out the antibiotic treatment regimens with the lowest cost for all-cause bacterial pneumonia, a study to compare the costs of different antibiotic regimens in the treatment of patients diagnosed with all-cause bacterial pneumonia who required hospitalisation was carried out.

Methodology: This was a multicentre, retrospective study of patient medical records. The primary aim was to examine whether the initial choice of antibiotic had affected the total cost of treatment, while the secondary aim was to find out whether the initial choice of antibiotic had affected the initial treatment failure rates and death rates. A cost-minimisation analysis (CMA) from a public hospital perspective was employed.

Results: A total of 333 patient medical case notes were reviewed. The most commonly prescribed antibiotic regimen was amoxycillin-clavulanate (AC) followed by amoxycillin-clavulanate plus macrolide (ACM) and quinolone (Q). In the study population, no statistical significance could be detected between the mean cost of the three regimens. In the subgroup analysis of patients with a history of chronic obstructive pulmonary disease (COPD) and patients with a history of smoking, the Q regimen appeared to be the least expensive.

Conclusion: In the study population, no significant difference could be identified between the mean cost of the three antibiotic regimens. In a special populations such as patients with a history of COPD and patients with a history of smoking, the Q regimen appeared to be superior. Further studies in these areas are needed.