Search

Background The clinical thinking of general medicine is based on the characteristics of the general medicine profession and has its uniqueness, requiring general practitioners to have "patient-centered" clinical diagnosis and treatment skills. In order to better reflect the clinical thinking ability of clinical residents in general practice, it is necessary to establish a set of effective evaluation criteria that can reflect all aspects of their ability. At present, there is no suitable method to evaluate the clinical thinking ability of residents in general practice. Objective To construct a post competency oriented clinical thinking ability evaluation system for general practice residents by Delphi method. Methods From December 2021 to February 2022, based on literature research, we preliminarily constructed the evaluation system framework of clinical thinking ability of general residents. Delphi method was used to conduct two rounds of in-depth communication with 12 experts to give objective evaluation on the importance of the indicators in the framework. Futher, we use analytic hierarchy process to determine the weight of each indicator. Results Through two rounds of expert consultations, we developed a comprehensive evaluation system consisting of 5 first-level indicators (clinical knowledge learning and extension, data collection and utilization, diagnostic analysis and utilization, treatment decision making ability, communication and collaboration ability) and 30 second-level indicators. The effective response rate of the two rounds of questionnaire was 100.0%, the expert authority coefficient was 0.85, and the expert coordination coefficient of the first and second indexes were 0.299 and 0.189 respectively (P

Objective To dectect six-minute walking distance (6MWD) of patients with multimorbidity by an intelligent six-minute walking test (6MWT) device, and to investigate the correlation of 6MWD with lung function, quality of life, and clinical indicators. Methods A total of 138 patients with multimorbidity who were hospitalized in the General Practice Department of Peking University Third Hospital from January to December 2022 were selected. 6MWT was conducted in patients, and pulmonary function before and after the test was measured, and the general data, height, weight, blood routine ［white blood cell (WBC) count, hemoglobin (Hb), platelet (PLT) count］, liver function ［albumin (ALB), aspartate aminotransferase (AST), alanine aminotransferase (ALT)］, renal function ［creatine (Cr), blood urea nitrogen (BUN), uric acid (UA)］, carbohydrate metabolism indicators ［fasting blood glucose (FPG), glycated hemoglobin (HbA1c)］, blood lipids ［total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C)］, echocardiographic indicators ［left ventricular end diastolic diameter (LAD), E peak, A peak, left ventricular ejection fraction］ and SF-36 scores were collected. The correlations between 6MWD and the above indicators were analyzed. Results Among the 138 patients, 58, 47, 23, and 10 patients coexisted with 2, 3, 4, 5 diseases respectively. 6MWD was positively correlated with height, pre- and post-test pulmonary function ［forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1/FVC］, physical function, role-physical, Hb, ALT, LDL-C (P＜0.05), and negatively correlated with age, FPG, HbA1c, and A-peak (P＜0.05). Conclusion 6MWD is correlated with cardiovascular function and quality of life in patients with multimorbidity, and can play an important role in evaluating and monitoring the overall function of patients with multimorbidity.

For the requirement of structural deformation measurement, a deformation measurement method based on structured light point clouds is proposed. A structured light measurement system is built, and the calibration process based on the assumption of the projector's reverse camera and with the help of the checkerboard calibration board is completed. The pattern projected by the projector is designed by using a four-step phase-shift technique assisted by Gray code. By combining with system parameters which have been calibrated, the three-dimensional reconstruction of the object surface is completed. A structural deformation measurement method based on the statistical analysis of the distance between point clouds is proposed, and the principles of three points cloud distance calculation methods including point-to-point, point-to-surface and surface-to-surface are analyzed. The feasibility and accuracy of the deformation measurement method based on the structured light point cloud proposed in this paper are verified via experiments. Experimental results show that this method can achieve out-plane high-precision displacement measurement of structures.

This study investigates the adsorption characteristics of the pristine MoTe2 monolayer and the metal atom (Co, V, W, Zr)-modified MoTe2 monolayer on the hazardous gases CO, CH3CHO, and C6H6 based on the density functional theory. The adsorption mechanism was studied from the perspectives of molecular density differences, band structures, molecular orbitals, and the density of states. Research analysis showed that the changes in conductivity caused by the adsorption of different gases on the substrate were significantly different, which can be used to prepare gas sensing materials with selective sensitivity for CO, CH3CHO, and C6H6. This study lays a reliable theoretical foundation for the gas sensing analysis of toxic and hazardous gases using metal atom-modified MoTe2 materials. [ABSTRACT FROM AUTHOR]

Considering the factors such as complex alternating load,meshing stiffness,meshing clearance,manufacturing and installation errors,the nonlinear multi-degree-of-freedom dynamics model of the clearance between the gear pair of the bridge crane reducer under complex excitation is established. By using the Runge-Kutta method of MATLAB/Simulink,the simulation solution of the nonlinear dynamic model of gear clearance is carried out. The effects of parameters such as load,tooth backlash,excitation frequency and damping ratio on the dynamic performance of the system are analyzed.

Based on the strength and modal analysis,the lightweight design of gearbox housing is carried out by using the topological optimization method. Under the condition of meet the reliability of the gearbox,the housing weight is reduced about 15% after structural optimization. The rationality of housing improvement is verified through the contrast analysis on the reducer housing performance before and after optimization.

Based on the relationship between shear stress and Hardness,using the linear regression method,the calculation formula of effective case depth of carburized gear was derived,and it was verified by example. The results show that the accuracy of the derived simple computational formula can meet the requirements for gear design. Using this formula,the effective case depth of gear was obtained,and the model for the distribution of effective case depth of gear was established.

In the case of dry friction,the stress value and distribution on and under contact surface of gear and rack are analyzed in terms of elasticity theory,the results show that the maximum shear stress moves to the tooth surface with the increase of friction factor,and the maximum shear stress mostly occurs on the nether boundary point of single tooth mesh area of the gear.

Based on a typical component in the large crane reducer as the object,a three-dimensional tolerance model is established.Through sensitivity numeric analysis,the critical and non-critical dimensions influencing the assembly requirements can be found out,the reasonable distribution of each component tolerances can be achieved,which lays a basis for the optimization of components accuracy design.

The frequency response analysis of gearbox housing of large- sized bridge crane is carried out under the excitation frequency,and the displacement response curves of every bearing bore on the housing and the greatest response position of the housing are obtained. The results show that when the meshing frequencies under the rated speed,the natural frequency of the housing can be avoided and it should not cause the resonance.

Nine new large-scale reaction centers were created in Rhodobacter capsulatus by the replacement of the M side protein segments with the L protein segment. Generally, the mutations resulted to the symmetrization of around 80% of the M subunit amino acids in contact with the cofactors responsible for initial electron transfer. The large-scale changes in the amino acid areas near the quinones and iron atom resulted to loss of photosynthetic viability. Electron transfer occurred in all but one mutant reaction center thereby proving that asymmetry was not a functional necessity in the center.

Low-temperature femtosecond-resolution transient absorption spectroscopy was performed on large-scale symmetry mutants of bacterial reaction centers constructed in Rhodobacter capsulatus by the substitution of the M subunit gene with the L subunit gene. All of the three isolated reaction centers were capable of undergoing electron transfer at 20 K. The sym0 and sym5-2 mutants were observed to undergo charge separation at rates and yields nearing wild type values whereas the rate in sym2-1 reflected the Tyr to Trp mutation at M208 than the Tyr to the Phe mutant.

Femtosecond pump-probe analysis of the energetics of the photosynthetic membranes of Rhodobacter capsulatus reveals that spectral and kinetic parameters of absorbance changes, due to charge separation in isolated reaction centers and membranes, are identical. Interexcitonic relaxation in light harvesting complex I (LHI) results in ultrafast energy relaxation of the LHI antenna. The transfer of excitation from LHI to reaction center limits the rate of energy trapping in membrane-bound LHI-reaction center complexes.

Background: Deficits in maintaining and manipulating sequential information online can occur even in patients with mild Parkinson's disease. The subthalamic nucleus may play a modulatory role in the neural system for sequential working memory, which also includes the lateral prefrontal cortex. Objectives: The objective of this study was to investigate neural markers of sequential working memory deficits in patients with de novo Parkinson's disease. Methods: A total of 50 patients with de novo Parkinson's disease and 50 healthy controls completed a digit ordering task during functional magnetic resonance imaging scanning. The task separated the maintenance ("pure recall") and manipulation of sequences ("reorder & recall" vs "pure recall"). Results: In healthy controls, individual participants' task accuracy was predicted by the regional activation and functional connectivity of the subthalamic nucleus. Healthy participants who showed lower subthalamic nucleus activation and stronger subthalamic nucleus connectivity with the putamen performed more accurately in maintaining sequences ("pure recall"). Healthy participants who showed greater ordering‐related subthalamic nucleus activation change exhibited smaller accuracy costs in manipulating sequences ("reorder & recall" vs "pure recall"). Patients performed less accurately than healthy controls, especially in "reorder & recall" trials, accompanied by an overactivation in the subthalamic nucleus and a loss of synchrony between the subthalamic nucleus and putamen. Individual patients' task accuracy was predicted only by the subthalamic nucleus connectivity. The contribution of the subthalamic nucleus activation or activation change was absent. We observed no change in the lateral prefrontal cortex. Conclusions: The overactivation and weakened functional connectivity of the subthalamic nucleus are the neural markers of sequential working memory deficits in de novo Parkinson's disease. © 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society [ABSTRACT FROM AUTHOR]