发展我国洪水保险的制度思考——美国洪水保险制度的借鉴与启示

洪水保险是一项重要的非工程防洪措施.美国是世界上最早建立国家强制性洪水保险体制的国家,经过艰难曲折的探索,闯出了一条成功之路.我国的洪水保险体制还处于积极探索阶段.中美两国尽管国情差异较大,但以洪水保险作为推进洪泛区洪水风险管理的经济手段,并以立法和国家计划等措施来保障实施的作法是值得借鉴的.本文就美国洪水保险制度的发展与沿革,寻找对我国建立洪水保险制度一些有益的启示,并就此提出了一些建设性意见.     

Development,implementation and impact of simple patient safety interventions in a university teaching hospital

ObjectiveTo determine the incidence of anesthesia patient safety incidents at a university teaching hospital, develop interventions to address the most common incidents, and determine the effectiveness of these interventions.Study designPre-post intervention observational.AnimalsFour thousand, one hundred forty dogs and cats anesthetized by the anesthesia service.MethodsThe study was divided into two 11.5 month periods. During each period, incidents were logged (e.g. closed adjustable pressure limiting (APL) valve, esophageal intubation, and medication error). At the end of the first period, four countermeasures were incorporated into the service’s protocols: 1) prior to any drug injection, the individual would read out aloud the drug name, patient name, and route of administration; 2) use of a uniquely colored occlusive wrap over arterial catheters; 3) a check box on the anesthesia record labeled “Technician Confirmed Intubation”; 4) a check box on the anesthesia record labeled “Technician Checked OR (operating room)”. The number of patient safety incidents during period 1 and period 2 were compared using Fisher’s Exact Test.ResultsDuring Period 1, there were 74 incidents documented in 2028 patients (3.6%) including 25 medication errors, 20 closed APL valves, and 16 of esophageal intubation. During Period 2, there were 30 incidents documented in 2112 patients (1.4%) including 14 medication errors, 5 closed APL valves, and 4 of esophageal intubation. The proportion of events during Period 2 was significantly smaller than during Period 1 (p < 0.0001).Conclusions and Clinical relevanceImplementation of four simple interventions was associated with a significant decrease in the number of incidents.     

Utility of on- and off-farm weather records for studies in genetics of heat tolerance

Utility of weather information from on-farm and weather stations was evaluated for the application in studies on the genetics of heat stress. Daily milk yield of 31 primiparous Holstein cows was collected at Tifton, GA, from April 28 to July 19, 1993. Weather information was recorded on-farm and was available from weather stations in Georgia. Analyses used daily average of temperature–humidity index (THI). Effects of threshold of heat stress and the rate of decline in milk after the threshold were estimated. With on-farm weather data, threshold was at THI = 22 and rate of decline was − 1.12 kg of milk per unit of THI measured 2 days before milking. At the Tifton weather station, 3 km away from the farm, the threshold was THI = 20 and the rate was the same. With data from Macon, Columbus, Atlanta, and Athens stations, the threshold was at 20, 21, 20, and 20, respectively, and the rate of decline with a 2 day lag was − 0.88, − 1.02, − 0.90, and − 0.97 kg of milk per unit of THI. Subsequent analysis included 2260 test day records from the same farm from 1993 to 2003 and weather data from Tifton station. The highest rate of decline on milk yield of − 0.22 kg per unit of THI occurred at the threshold of 20 and no lag. For data restricted to 1999–2003, the threshold increased to 22 and the rate to − 0.46 kg per THI unit. Public stations provide satisfactory information for national genetic evaluation for heat stress. Critical parts in such an evaluation are modeling of test days and accounting for changes among farms and weather stations over time.     

2012年莱西市奶牛布鲁氏菌病血清学调查和风险因素分析

[目的]估计莱西市奶牛布鲁氏菌病的流行率和地理分布,分析奶牛养殖场间布鲁氏菌病的传播风险因素。[方法]对莱西市1803个养殖户30119头应检奶牛,全部采样,采用虎红平板凝集和试管凝集垂直试验,同时开展奶牛布鲁氏菌病问卷调查。利用GIS、Epi Infor TM 7和SPASS软件,开展横断面研究和case-control研究,分析莱西市奶牛布鲁氏菌病阳性场户的空间分布、布鲁氏菌病流行率和养殖场间的风险因素分析。[结果]莱西市布鲁氏菌病的场户血清流行率是2.55%,个体血清流行率为0.38%;单因素分析发现存栏量、养殖模式、养殖环境、是否有专用产犊场地、挤奶方式、运奶方式、粪污是否分开处理、是否使用机械处理粪便等8个因素与奶牛布鲁氏菌病发生有一定关系（p<0.2）;多因素logistic回归分析表明,存栏量少（10只以下）（OR=4.58,95%CI：1.87-11.23,p=0.001）和散养户集中村饲养（OR=2.21,95%CI：1.05-4.63,p=0.036）与该病发生相关。     

A complication probability planning study to predict the safety of a new protocol for intracranial tumour radiotherapy in dogs

Technical advances make it possible to deliver radiation therapy for canine intracranial tumours in fewer fractions, under the assumption of equivalent tumour control. With the aim of estimating the late toxicity risk profile for various tumour sizes and locations, the present paper evaluates the normal tissue complication probability (NTCP) values for the intracranial organs at risk. By making isoeffect calculations, a new 10‐fraction radiation protocol was developed with the same tumour control probability (TCP) as a currently used 20‐fraction standard protocol, and complication risk profiles for brain, brainstem and optic chiasm were modelled using a representative population of 64 dogs with brain tumours. For >59% of cases, the new 10‐fraction protocol yielded an acceptable, low risk estimate of late toxicity (<10%). Our calculations suggest that it may be safe to treat small to intermediate‐sized tumours that are neither located near the optic chiasm nor at the brainstem with 10 daily fractions of 4.35 Gy.     

河北省承德市接坝地区畜间包虫病感染风险因素研究

为寻找河北省承德市接坝地区牛羊群包虫病潜在风险因素,对承德市接坝地区23个乡镇的184个养殖户进行风险因素问卷调查,并分析调查结果。结果显示,牛羊养殖方式粗放、犬粪不进行无害化处理、犬密切接触羊牛群、驱虫后没有对犬进行拴养是包虫病感染的重要风险因素。通过Hosmer-Lemeshow检验,证明建立的Logistic回归模型拟合较好。结果表明,养殖户加强牛羊管理,对犬合理驱虫,限制散养犬接触牛羊群对于降低包虫病感染风险具有重要意义。     

Risk Sensitivity and Hunter Perceptions of Chronic Wasting Disease Risk and Other Hunting,Wildlife, and Health Risks

This article examined relationships among hunter perceptions of personal health risks from chronic wasting disease (CWD), knowledge and information about CWD, and perceptions of other hunting, wildlife, and health risks. Data were obtained from surveys of 2,725 deer and elk hunters in Colorado. Cluster analysis grouped hunters into no (42%), slight (44%), and moderate (14%) risk groups based on perceptions of personal health risks from CWD (e.g., concern about health, become ill from CWD). There were minimal differences among groups in demographics, information sources, and knowledge about CWD. Hunters who perceived higher health risks from CWD (i.e., moderate risk), however, perceived greater risks associated with CWD to other humans, CWD to wildlife, hunting to personal health, other diseases to health, and the future of hunting. These findings illustrated the concept of risk sensitivity where hunters who perceived higher risks from CWD were predisposed to rate all other risks as large.     

Seroepidemiology of Hepatitis E in Selected Population Groups in Croatia: A Prospective Pilot Study

Hepatitis E has become an emerging infection in many European countries. We analysed the prevalence of hepatitis E virus (HEV) infection in selected population groups in Croatia. Overall HEV IgG seropositivity was 5.6%, while 1.9% participants showed IgM antibodies suggestive of recent infection. No IgM‐positive sample was positive for HEV RNA. HEV IgG antibodies were most prevalent in alcohol abusers (8.9%) and war veterans (8.6%), compared with 6.1% among injecting drug users and 2.7% in healthcare professionals. No individual with high‐risk sexual behaviour tested HEV seropositive. HEV IgG positivity increased significantly with age from 1.8% to 2.3% in individuals younger than 40 years to 11.3% in individuals older than 50 years (P = 0.023). The mean age of HEV‐positive participants was significantly higher than that of HEV‐negative participants (50.9 ± 11.8 years versus 41.2 ± 11.8 years, P = 0.008). Seroprevalence rates were significantly higher in residents of suburban and rural areas compared with residents of urban areas (14.5% versus 2.5%, P = 0.003). Additionally, an increasing prevalence of HEV IgG antibodies was observed from 1.8% in participants living in families with two household members to 12.1% in those living with more than four members (P = 0.046). Gender, marital status, educational level, sexual orientation, source of drinking water, history of blood transfusions, surgical procedures, tattooing and travelling were not associated with HEV seroprevalence. Logistic regression showed that living in suburban/rural areas was the main risk factor for HEV seropositivity (OR = 6.67; 95%CI = 1.89–25.0; AOR = 7.14, 95%CI = 1.89–25.0).     

Sole ulcers in Finnish dairy cattle

The Finnish Healthy Hooves project was set up to determine the frequency of, and risk factors for various hoof lesions in Finnish dairy herds. Data were collected in the years 2003 and 2004. A large dataset of over 74,000 cow-level observations recorded by hoof trimmers was merged with production data from the Finnish Agricultural Data Processing Centre Ltd. Ultimately, data from a single lactation from each of 16,792 cows in 703 herds were used for the analyses in this paper. Three-level hierarchical logistic models with hoof trimmer and farms (within hoof trimmer) as random effects were fit to data sets of tie stall (TS) and loose housing (LH) herds separately. The outcome of interest was the presence or absence of a sole ulcer in one or more legs of a cow during the lactation of interest.Cows examined once had a risk of sole ulcer 5.23% in tie stall herds and 7.58% in LH herds. As the number of examinations increased the odds of a diagnosis of sole ulcer increased substantially (2 and 3+ examinations had odds ratios (ORs) of 1.42 and 3.42 in TS herds and 2.77 and 6.89 in LH herds). Breed had a large effect on the risk of sole ulcer with Holsteins 2.89 times more likely to be affected than Ayrshires in TS herds and 2.94 times in LH herds. In TS herds, the presence of other hoof lesions such as haemorrhages (OR = 2.97), heel-horn erosions (OR = 2.10) and corkscrew claw (OR = 2.83) increased the risk of a sole ulcer developing. In LH herds, only haemorrhages (OR = 1.80) were a significant risk factor when parity was ≥2. In TS herds, use of mats (compared to hard flooring) significantly reduced the risk of sole ulcers (OR = 0.49). The effect of parity on the risk of sole ulcer was greatest when parity ≥4 but this effect was only significant in tie stalls (OR = 1.86).When analyses were restricted to cows with parity ≥2, similar results were obtained for the risk factors identified above. In addition, parity became highly significant in TS and LH (OR 2.31 and 2.23, respectively when parity was 4+). In TS herds, herd average milk production was significantly associated with a decrease risk of sole ulcer (OR = 1.28 per 1000 kg decrease) but there was no effect of production at the cow level (measured as deviation from the herd mean). No significant effects of production were observed in LH herds.