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Temporal trends and practice variation of paediatric diagnostic tests in primary care:retrospective analysis of 14 million tests

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Family Medicine and Community Health 2024年第4期12卷 1-8页

作者： Elizabeth T Thomas Diana R Withrow Cynthia Wright Drakesmith Peter J Gill rafael Perera-Salazar Carl Heneghan Centre for Evidence-Based Medicine Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK Nuffield Department of Primary Care Health Sciences University of OxfordOxfordUK Department of Pediatrics University of TorontoTorontoOntarioCanada Hospital for Sick Children TorontoOntarioCanada

objective The primary objective was to investigate temporal trends and between-practice variability of paediatric test use in primary *** and analysis This was a descriptive study of population-based data from Clinical Practice Research Datalink Aurum primary care consultation records from 1 January 2007 to 31 December *** aged 0–15 who were registered to one of the eligible 1464 general practices and had a diagnostic test code in their clinical record were *** primary outcome measures were(1)temporal changes in test rates measured by the average annual percent change,stratified by test type,gender,age group and deprivation level and(2)practice variability in test use,measured by the coefficient of *** 14299598 diagnostic tests were requested over 27.8 million child-years of observation for 2542101 *** test use increased by 3.6%/year(95%CI 3.4 to 3.8%)from 399/1000 child-years to 608/1000 child-years,driven by increases in blood tests(8.0%/year,95%CI 7.7 to 8.4),females aged 11–15(4.0%/year,95%CI 3.7 to 4.3),and children from the most socioeconomically deprived group(4.4%/year,95%CI 4.1 to 4.8).Tests subject to the greatest temporal increases were faecal calprotectin,fractional exhaled nitric oxide and vitamin *** classified as high-use and high-practice variability were iron studies,coeliac testing,vitamin B12,folate,and vitamin *** In this first nationwide study of paediatric test use in primary care,we observed significant temporal increases and practice variability in *** reflects inconsistency in practice and diagnosis rates and a scarcity of evidence-based *** test use generates more clinical activity with significant resource implications but conversely may improve clinical *** research should evaluate whether increased test use and variability are warranted by exploring test indications and test results and directly examine how increased test use impacts

关键词： vitamin nationwide stratified

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Gene therapy for spinal muscular atrophy:perspectives on the possibility of optimizing SMN1 delivery to correct all neurological and systemic perturbations

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Neural Regeneration Research 2025年第7期20卷 2011-2012页

作者： Sharon J.Brown rafael J.Yáñez-Muñoz Heidi R.Fuller School of Pharmacy and Bioengineering Keele UniversityKeeleUK Wolfson Center for Inherited Neuromuscular Disease TORCH BuildingRJAH Orthopaedic HospitalOswestryUK *** Center of Gene and Cell TherapyDepartment of Biological SciencesSchool of Life Sciences and the EnvironmentRoyal Holloway University of LondonEghamUK

Spinal muscular atrophy(SMA)is a genetic condition that results in selective lower motor neuron loss with concomitant muscle weakness and *** genetic cause of SMA was understood in 1995 when loss or impairment of the survival motor neuron 1(SMN1)gene was identified as the main contributing factor(Lefebvre et al.,1995).This,in combination with the discovery that humans have a“back-up”gene,SMN2,which can produce low levels(approximately 10%)of the full-length functional SMN protein,has led to the generation of SMA-specific gene *** was traditionally classified according to age of symptom onset and developmental milestones achieved,with life expectancy and severity varying between ***,SMN2 copy number is used as a proxy for the prediction of disease severity,with higher SMN2 copy number typically being associated with reduced severity of SMA,although this relationship is not absolute:some individuals with low SMN2 copy number have less severe SMA phenotypes and vice ***,the etiology of SMA is further complicated by other factors,such as non-typical nucleotide variants and SMN2-independent modifiers of disease severity.

关键词： atrophy traditionally absolute

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促进慢性阻塞性肺疾病哮喘患者自我监控空气质量的护理干预措施: 整合性综述

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International Journal of Nursing Sciences 2024年第1期11卷 46-56页

作者： Bruna F.Sebastiao Raquel M.Hortelao Sara S.Granadas Jose M.Faria Joana R.Pinto Helga rafael Henriques Nursing School of Lisbon LisbonPortugal Hospital Center of Central Lisbon Portugal CUF Tejo Hospital LisbonPortugal University Hospital Center of Northern Lisbon LisbonPortugal Nursing Research Innovation and Development Centre of Lisbon(CIDNUR)LisbonPortugal

目的哮喘-慢性阻塞性肺疾病肺重叠症(Asthma-chronie obst ructive pulmonary disease overlap,A-Co)患者的生活质量较低,肺功能较差,病情经常加重。由于暴露于污染环境会加重其症状,增加发病率和病死率,环境管理对其至关重要。旨在通... 详细信息

目的哮喘-慢性阻塞性肺疾病肺重叠症(Asthma-chronie obst ructive pulmonary disease overlap,A-Co)患者的生活质量较低,肺功能较差,病情经常加重。由于暴露于污染环境会加重其症状,增加发病率和病死率,环境管理对其至关重要。旨在通过系统性综述,寻找证据,以指导制订护理干预措施,促进ACo患者对空气质量的自我管理。方法2023年3月 ,系统检索CINAHL、Medline、Academie Search Complete .Scopus、WebofScience、Cochrane图书馆、乔安娜布里格斯研究所(JoannaBriggsInstitute,JBI)循证实践数据库,以及GoogleScholar。对纳人研究进行数据提取和综合,并对护理干预措施进行分类。采用JBI研究质量评估工具进行方法学质量评估。结果共纳入5篇来自不同国家的研究。促进ACo患者自我监控空气质量的干预措施包括:警觉性干预措施(医务人员定期巡诊、进行症状评估),监测干预措施(监测室内外诱发因素) ,教育干预措施(空气质量警报、避免接触过敏原),以及相关政策的影响,如无烟政策和改善空气质量的综合战略。尽管这些研究报告了不同的干预措施,方法质量也存在差异,但这些干预措施显示了预防患者病情恶化、尽量减少急诊就诊和住院治疗的潜力。这些关键点可作为护理干预措施的关键组成部分。结论有必要采取全面措施,让护士参与促进患者自我监控空气质量的多学科团队.提高认识、制订和实施护理干预,从而使ACo患者受益。同时,需要进--步开展研究,以扩大证据基础并完善这些干预措施。

关键词：空气质量哮喘哮喘-慢阻肺重叠慢性病慢性阻塞性肺疾病护理自我管理

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Imaging the Architecture of Mineral Systems and the Pathways of ore-forming Fluids across Mongolia with Magnetotellurics

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Acta Geologica Sinica(English Edition) 2024年第S1期 11-13页

作者： Matthew J.CoMEAU rafael RIGAUD Erdenechimeg BATMAGNAI Shoovdor TSERENDUG Sodnomsambuu DEMBEREL Michael BECKEN Alexey KUVSHINoV Department of Geoscience & Engineering Delft University of Technology Institute of Geophysics ETH Institute of Astronomy and Geophysics Mongolian Academy of Sciences Institut für Geophysik Universit?t Münster

In the framework of a mineral system approach, a combination of components is required to develop a mineral system. This includes the whole-lithosphere architecture, which controls the transport of ore-forming fluids, and favorable tectonic and geodynamic processes, occurring at various spatial and temporal scales, that influence the genesis and evolution of ore-forming fluids(Huston et al., 2016; Groves et al., 2018; Davies et al., 2020). Knowledge of the deep structural framework can advance the understanding of the development of a mineral system and the emplacement of mineral deposits. Deep geophysical exploration carried out with this aim is increasingly important for targeting new ore deposits in unexplored and underexplored regions(Dentith et al., 2018; Dentith, 2019).

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Liver transplantation as an alternative for the treatment of perihilar cholangiocarcinoma: A critical review

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Hepatobiliary & Pancreatic Diseases International 2024年第2期23卷 139-145页

作者： Wellington Andraus Francisco Tustumi Alexandre Chagas Santana rafael Soares Nunes Pinheiro Daniel Reis Waisberg Liliana Ducatti Lopes Rubens Macedo Arantes Vinicius Rocha Santos Rodrigo Bronze de Martino Luiz Augusto Carneiro D’Albuquerque Department of Gastroenterology Transplantation UnitUniversidade de São PauloSão PauloBrazil

Background:Perihilar cholangiocarcinoma(phCCC)is a dismal *** is no consensus regard-ing the best treatment for patients with unresectable *** present review aimed to gather the current pieces of evidence for liver transplantation and liver resection as a treatment for phCCC and to build better guidance for clinical *** sources:The search was conducted in PubMed,Embase,Cochrane,and *** related references were searched *** criteria were:reports in English or Portuguese literature that a)patients with confirmed diagnosis of phCCC;b)patients treated with a curative intent;c)patients with the outcomes of liver resection and liver *** reports,reviews,letters,editorials,conference abstracts and papers with full-text unavailability were excluded from the ***:Most of the current literature is based on observational retrospective studies with low grades of *** resection has better long-term outcomes than systemic chemotherapy or palliation ther-apy and liver transplantation is a good alternative for selected patients with unresectable *** candidates for resection or transplantation should be medically fit and free of intrahepatic or extrahep-atic *** a general rule,patients presenting with a tumor having a longitudinal size>3 cm or extending below the cystic duct,lymph node disease,confirmed extrahepatic dissemination;intraoper-atively diagnosed metastatic disease;a history of other malignancies within the last five years,and did not complete chemoradiation regimen and were medically unfit should not be considered for *** of these criteria should be individually *** transplantation or resection should only be considered in highly experienced hepatobiliary centers,and any decision-making must be based on a multidisciplinary ***:phCCC is a complex condition with high *** therapies,including hepatec-tomy and liv

关键词： Liver transplantation Cholangiocarcinoma Liver neoplasms

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利用掺杂层研究磁化靶中的能斯特效应

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强激光与粒子束 2024年第9期36卷 169-174页

作者：陈诗佳张华周沧涛卓红斌吴福源 rafael Ramis 深圳大学应用技术学院广东深圳518060 深圳技术大学深圳市超强激光与先进材料技术重点实验室超强激光应用技术研究中心工程物理学院广东深圳518118 上海交通大学物理与天文学院上海200240 马德里理工大学航空航天学院马德里E-28040

双层磁化套筒靶在内层采用高原子序数(Z)材料,减少了因能斯特效应导致的磁通损失并降低点火要求,为磁化靶聚变提供了一种备选方案。然而,添加高Z材料也可能增加由于物质混合而产生的辐射损失。通过在金属套筒中使用带有塑料掺杂的锗作为... 详细信息

双层磁化套筒靶在内层采用高原子序数(Z)材料,减少了因能斯特效应导致的磁通损失并降低点火要求,为磁化靶聚变提供了一种备选方案。然而,添加高Z材料也可能增加由于物质混合而产生的辐射损失。通过在金属套筒中使用带有塑料掺杂的锗作为高Z替代物,初步分析了磁场能斯特输运和物质混合对磁化套筒惯性聚变的影响。与单层套筒相比,双层套筒靶展示出温度和磁通的显著增加,从而使聚变产额提高了154%。将碳氢掺杂剂添加到最内层的锗中,模拟了物质混合对聚变产额的影响。研究结果表明,锗与CH混合,保持较低的混合比例,能够显著提高聚变产额。

关键词：双层套筒磁化靶聚变能斯特效应掺杂物质混合

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Impact of data balancing a multiclass dataset before the creation of association rules to study bacterial vaginosis

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Intelligent Medicine 2024年第3期4卷 188-199页

作者： Freddy de la Cruz-Ruiz Juana Canul-Reich rafael Rivera-López Erick de la Cruz-Hernández Academic Division of Science and Technology of the Information Juárez Autonomous University of TabascoLa Esmeralda DistrictTabascoMexico Department of Systems National Technological Institute of MexicoTechnological Institute of VeracruzVeracruzMexico Multidisciplinary Academic Division of Comalcalco Juárez Autonomous University of TabascoTabascoMexico

Background Bacterial vaginosis is a polymicrobial syndrome in which the homeostasis exerted by the Latobacillus species that protect the vaginal mucosa has been *** study explored the data balancing process with the intention of improving the quality of association *** article aimed to balance the unbalanced multiclass dataset to improve association rule *** A dataset with 201 observations and 58 variables was analyzed.A preconstructed dataset was *** authors collected the data between August 2016 and october 2018 in Tabasco,*** study population comprised sexually active women ages 18 to 50 who underwent gynecological inspection at the infectious and metabolic diseases research laboratory at the Universidad Juarez Autonoma de *** determine the best κ-value,the random-forest algorithm was used and the balancing was performed with the synthetic minority over-sampling technique(SMoTE),random over-sampling examples(RoSE),and adaptive syntetic sampling approach for imbalanced learning(ADASYN)*** Apriori algorithm created the rules and to select rules with statistical significance,the ***(),***(),and ***()functions and quality metric Fisher’s exact tes were *** biological validation was carried out by the expert(bacteriologist).Results The ADASYN algorithm at K=9 the out of the bag(ooB)error was zero,this was the best𝐾-*** the balancing process the ADASYN algorithm show best the *** the dataset balanced with ADASYN,the apriori algorithm created the association rules and the selection with the quality metric Fisher’s exact test,and the biological validation reported 13 ***-bacteria Atopobium vaginae,Gardnerella vaginalis,Megasphaera filotipo 1,Mycoplasma hominis and Ureaplasma parvum were detected by the apriori algorithm from the balanced *** Balancing may improve the creation of association rules to efficiently model the bacteria that cause bac

关键词： Bacterial vaginosis Data balancing Random forest Synthetic minority over-sampling technique

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Impact Containment Barriers with Geotextile Tubes

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Journal of Geoscience and Environment Protection 2024年第5期12卷 325-344页

作者： Flávio da Silva ornelas Luís Fernando Martins Ribeiro rafael Cerqueira Silva Instituto Federal de Educaç &#227o Ci&#234ncia e Tecnologia&#8212IFTO Palmas Brasil Departamento de Engenharia Civil e Ambiental Programa de p&#243s gradua&#231&#227o em Geotecnia Universidade de Bras&#237lia&#8212UnB/Campus Universit&#225rio Darcy Ribeiro Bras&#237lia Brasil

Recently, tragic tailings dam collapses in Brazil have caused deaths and major destruction and the need to develop technologies capable of preventing damage to people and the environment. Brazilian tailings dams are in a situation of uncertainty due to new legislation that even requires decommissioning, an activity that involves many problems and where the risk of failure is the main one. An impact containment structure downstream of these dams can be effective and geotextile tubes, in a new approach, have emerged as an option with advantages in terms of execution, costs and safety. The technology is versatile and can bring many benefits such as the reuse of tailings or filling with low-energy or reused materials. In this research, geotextile tubes were tested as free containment barriers, experiencing impacts in reduced models. The safety factor for the stability of the structure was constructed using an equation which is the ratio between the self-weight of the barrier structure and its coefficient of static friction and the impact pressure, where the data showed an adequate correlation which suggests the viability of mitigating risks.

关键词： Geotextile Tube Debris Flow Barriers Impact Mining

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Typhoon-and pollution-driven enhancement of reactive bromine in the mid-latitude marine boundary layer

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National Science Review 2024年第4期11卷 93-101页

作者： Shanshan Wang Qinyi Li Ruifeng Zhang Anoop Sharad Mahajan Swaleha Inamdar Nuria Benavent Sanbao Zhang Ruibin Xue Jian Zhu Chenji Jin Yan Zhang Xiao Fu Alba Badia rafael P.Fernandez Carlos A.Cuevas Tao Wang Bin Zhou Alfonso Saiz-Lopez Shanghai Key Laboratory of Atmospheric Particle Pollution and Prevention (LAP3) Department of Environmental Science and Engineering Fudan University Institute of Eco-Chongming(IEC) Department of Atmospheric Chemistry and Climate Institute of Physical Chemistry Blas CabreraCSIC Department of Civil and Environmental Engineering The Hong Kong Polytechnic University Environment Research Institute Shandong University Centre for Climate Change Research Indian Institute of Tropical MeteorologyMinistry of Earth Sciences Department of Chemistry University of Colorado Boulder Institute of Environment and Ecology Tsinghua Shenzhen International Graduate SchoolTsinghua University Sostenipra Research Group Institute of Environmental Science and Technology(ICTA)Universitat Autonoma de Barcelona(UAB) Institute for Interdisciplinary Science (ICB) National Research Council (CONICET)

Tropospheric reactive bromine is important for atmospheric chemistry,regional air pollution,and global *** studies have reported measurements of atmospheric reactive bromine species in different environments,and proposed their main sources,***-salt aerosol（SSA）,oceanic biogenic activity,polar snow/ice,and *** and other strong cyclonic activities（***） induce abrupt changes in different earth system processes,causing widespread destructive ***,the role of typhoons in regulating reactive bromine abundance and sources remains ***,we report field observations of bromine oxide（Bro）,a critical indicator of reactive bromine,on the Huaniao Island（HNI）in the East China Sea in July *** observed high levels of Bro below 500 m with a daytime average of9.7±4.2 pptv and a peak value of ～26 pptv under the influence of a *** field measurements,supported by model simulations,suggest that the typhoon-induced drastic increase in wind speed amplifies the emission of SSA,significantly enhancing the activation of reactive bromine from SSA *** also detected enhanced Bro mixing ratios under high Noxconditions（ppbv level） suggesting a potential pollution-induced mechanism of bromine release from *** elevated levels of atmospheric bromine noticeably increase ozone destruction by as much as ～40% across the East China *** the high frequency of cyclonic activity in the northern hemisphere,reactive bromine chemistry is expected to play a more important role than previously thought in affecting coastal air quality and atmospheric oxidation *** suggest that models need to consider the hitherto overlooked typhoon-and pollution-mediated increase in reactive bromine levels when assessing the synergic effects of cyclonic activities on the earth system.

关键词： reactive bromine atmospheric chemistry marine boundary layer atmospheric oxidation capacity marine emission

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Free and open source software for geospatial applications(FoSS4G)to support Future Earth

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International Journal of Digital Earth 2017年第4期10卷 386-404页

作者： Maria Antonia Brovelli Marco Minghini rafael moreno-Sanchez Ricardo oliveira Department of Civil and Environmental Engineering Politecnico di MilanoComoItaly Department of Geography and Environmental Sciences University of Colorado DenverDenverCOUSA

The development,integration,and distribution of the information and spatial data infrastructure(*** Earth;DE)necessary to support the vision and goals of Future Earth(FE)will occur in a distributed fashion,in very diverse technological,institutional,socio-cultural,and economic contexts around the *** complex context and ambitious goals require bringing to bear not only the best minds,but also the best science and technologies *** and open Source Software for Geospatial Applications(FoSS4G)offers mature,capable and reliable software to contribute to the creation of this *** this paper we point to a selected set of some of the most mature and reliable FoSS4G solutions that can be used to develop the functionality required as part of DE and *** provide examples of large-scale,sophisticated,mission-critical applications of each software to illustrate their power and capabilities in systems where they perform roles or functionality similar to the ones they could perform as part of DE and *** provide information and resources to assist the readers in carrying out their own assessments to select the best FoSS4G solutions for their particular contexts and system development needs.

关键词： open source software geospatial software FoSS4G Future Earth Digital Earth

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