关键词： Rheumatology   alternative care providers   queueing theory   mean value analysis   simulation  

摘要： Patients diagnosed with rheumatoid arthritis require lifelong monitoring by a rheumatologist. Initiation of the disease-modifying anti-rheumatic drug therapy within twelve weeks of the onset of symptoms is crucial to prevent joint damage and functional disability. We examine the impact of the engagement of alternate care providers (ACP) in alleviating delay due to limited rheumatologist capacity. Using queueing theory and discrete-event simulation, we model rheumatologist-only and rheumatologist-with-ACP system configurations as closed, multiclass queueing networks with class *** summary data from an actual rheumatology clinic for illustration, we analyze various parameter conditions to aid clinic managers and policymakers in decisions concerning capacity allocations and feasible patient panel size that impact timeliness of care and resource *** not only confirm that a substantial increase in RA patient panel size with an ACP involved in the care of follow-up patients but also demonstrates the boundaries for feasible panel sizes and workload allocation

关键词： Arginase   glycemic status   nitric oxide synthase   sexual dimorphism   type 1 diabetes mellitus  

摘要： Background: Sexual dimorphism in specific biochemical pathways and immune response, underlies the heterogeneity of type 1 diabetes mellitus (T1DM) and affects the outcome of immunotherapy. Arginase and nitric oxide (NO) synthase (NOS) metabolize L-arginine and play opposite roles in the immune response and autoimmune processes. Objective: We hypothesized that the above mentioned enzymes can be involved in sex and age differences in T1DM and its treatment. Based on this, the enzymes have been studied in peripheral blood leukocytes (PBL) and plasma of young people with T1DM. Methods: Patients were recruited from Muratsan University Hospital (Yerevan, Armenia) and were divided into groups: girls and boys by age, from children to adolescents and adolescents/young adults with recent-onset T1DM (RO-T1DM) (0.1-1 years) and long-term T1DM (LT-T1DM) (1.6-9.9 years). Arginase activity was assessed by L-arginine-dependent production of L-ornithine, and the NOS activity was assessed by NO/nitrite production. Glycemic control was assessed using hemoglobin A1c test. Plasma HbA1c concentration below 7.5% (median (range) 6.7 [6.2-7.5]) was taken as good glycemic control (+) and above 7.5% (median (range) 10.5 [7.6-13]) as poor glycemic control (-). Healthy volunteers with corresponding sex and age were used as the control group. Results: All the patients with RO-T1DM, with poor glycemic control, had increased arginase activity in the cytoplasm (cARG) and mitochondria (mARG) in PBL. In girls with RO-T1DM, with good glycemic control, the subcellular arginase activity decreased, and normalized in LT-T1DM, regardless of age. In contrast, boys from both age groups showed high arginase activity, regardless of glycemic control and duration of T1DM along with insulin therapy. At the same time, a significant decrease in the subcellular production of bioavailable NO was observed in children/preadolescents, regardless of glycemic control and duration of diabetes. In adolescents/young adult bo

关键词： 造船行业   产品数据管理   PDM集成   大规模数据   队列  

摘要： 文章从PDM系统与其他系统的集成内容、集成方式、集成难点和技术选型等方面全面地阐述了SPDM系统在数据集成方面的应用模式。旨在总结SPDM系统与其他系统集成技术的选择和实现,分析其中的得失优劣,供后续开发系统参考。

关键词： 多元智能   小学音乐教育   学科联动教学  

摘要： 在全球化大背景下,“以人为本,因材施教”的教育理念深入人心。美国哈佛大学教育研究院的心理发展学家霍华德·加德纳(Howard Gardner)提出的多元智能理论强调,要关注学生在不同智能领域的发展。目前,该理论已被运用到各学科的教学之中。当然,音乐学科的教育教学也深受这一理论的启发。本文将在多元智能理论的基础上,对我国小学音乐教育与其他学科联动教学展开探索。

关键词： 新金融工具准则   新财务报表格式   其他综合收益   会计政策  

摘要： 各类具体会计准则在实际运用环节,需要考虑本准则与其他具体准则、其他会计规范甚至其他法规的协调问题。本文以“其他权益工具投资”为例,紧扣金融工具准则和财务报表列报准则,探讨不能重分类进损益的其他综合收益涉及的有关资产或交易在终止确认时转入留存收益的会计处理规范;结合金融工具准则、财务报表列报准则的演变历史,分析容易发生不当处理的原因,并对常见指导性案例的会计处理提出完善建议。

关键词： 文言文教学   文言实词   一遍遍   文言文学习   初中语文教师   生活体验   特殊句式   通假字  

摘要： 文言文难教。初中语文教师大多有过此感叹。究其因有二。刚接触文言文的初中生,没有文言文学习的经验,只能在教师的要求下一遍遍机械地诵读。在文言文教学中,教师大多注重对文言实词意义、虚词用法、通假字、古今异义词、一词多义现象、特殊句式等古汉语知识的讲解。一篇篇文优质美的名作被肢解成一个个分散的知识点。学生文本之间缺乏对话。学生的生活体验及自我的认知得不到尊重。久而久之,学生对文言文学习失去了兴趣。

关键词： 《简化字总表》   繁体字   文献考证   文字说明   简化字   异体字   数据准确  

摘要： 1稿件要求1.1稿件要求论点明确,论据充分,论证严谨,层次清晰,文字精炼,数据准确,具有一定的先进性和实用性。1.2稿件请用简化字概写,并以1986年10月重新公布的《简化字总表》为准,不用繁体字和异体字(中医文献考证除外)。1.3图表应有自明性,能用文字说明的尽量不用图表。

关键词： 坦索罗辛   输尿管结石   联合用药  

摘要： 坦索罗辛作为高选择性α1受体抑制剂,是临床上治疗前列腺良性增生的主要药物,与其他药物联合使用治疗输尿管结石成为研究热点,受到了国内外许多专家和学者本的广泛关注。文章系统总结了坦索罗辛与其他药物联合用药的疗效情况,旨在为寻求当前探索所遇到的问题以及未来研究的趋势,为该领域的进一步研究提供参考。

关键词： 口臭   口腔异味   整体观念   病因病机  

摘要： 本文通过对口臭病因病机的探讨和对古代文献的分析发现口臭不仅预示口腔疾病,还与脏腑功能的异常有着千丝万缕的关系,强调了中医辨证论治的整体观念。区分口臭、口酸、口苦、口甘、口咸之间的差异,论述口腔异味和脏腑的关系,以指导临床脏腑辨证。

关键词： Diet   Extensive agriculture   Farmland   Foraging efficiency   Poland   Vertebrates  

摘要： The intensification of farm management practices on grasslands has reduced the abundance of many species of animals. Mowing, a procedure essential to the continuing existence of farmland meadows, inevitably causes mortality among the animals inhabiting them, especially invertebrates, and exposes sites where white storks Ciconia ciconia can forage conveniently and more efficiently. We studied the foraging activities of storks on meadows being mown and compared these with the birds' foraging patterns on unmown meadows and meadows cleared of hay in the extensively managed farming landscape of east-central Poland. Foraging success was deemed to be the capture of a prey item as manifested by the stork raising its head and swallowing prey item. The storks' foraging success on meadows being mown was roughly the same as on unmown meadows but was significantly lower than on those cleared of hay. The number of steps taken by storks - a measure of the energy they expended on foraging - was far higher on meadows being mown than on unmown ones. Even so, on meadows being mown, storks caught proportionately more vertebrates (voles) (5.2% of all prey items) than on cleared meadows (1.4%) and unmown meadows (0.2%). The fact that vertebrates are considerably energy-richer than invertebrates was probably the main reason why storks were attracted to forage on meadows being mown, even though their foraging efficiency was not particularly high - an aspect emphasised in the literature. The sequential (asynchronous) mowing of the highly fragmented, semi-natural meadows in this part of Poland coincides with the time when storks are feeding their young. This is probably a key aspect governing the high density of this species.