华北早二叠世鳞木类大孢子囊-孢子叶复合体—无被果孢属(Achlamydocarpon Schumacker-Lambry)的研究

本论文系统回顾了无被果孢属的研究历史，讨论了无被果孢属的鉴定特征及种的划分依据，总结了无被果孢属已有种的特征及分布。在此基础上对山西太原西山煤田太原组7号煤层煤核及河北平泉杨树岭煤矿太原组火山凝灰岩中的无被果孢属进行了详细的解剖学研究，把它们与无被果孢属已有种进行了详细的对比后，共鉴定出二个新种和二个未定种。这二个新种的主要特征如下： 过渡无被果孢（新种）Achlamydocarpon intermedia sp. nov. 大孢子囊大约长6.0－10.0 mm，宽4.6 mm，高1.4mm，背腹扁状，具顶脊，两侧角明显, 近轴端开口。孢子囊壁复杂，分化为三层：最外层为单层柱状细胞层;中层1－2层细胞厚，细胞具深色内含物，壁薄;内层1－3层细胞厚，细胞壁强烈加厚。柱状层朝近轴端方向厚度加大。大孢子叶柄背脊不甚发育，具明显侧翼，侧翼的末端膨大并下垂使得柄的横切面略呈 “M”形。侧翼的宽度由近轴端向远轴端随孢子囊宽度的增加而增加，整体宽度大致保持为孢子囊的宽度的1/2左右。侧翼的近轴面具对称的厚壁组织区域。木质部束在近轴端为近等径状，向远轴端则变为略呈水平伸长状。通气组织发达，独立空腔结构贯穿孢子叶柄的整个长度。败育大孢子似乎具肿块结构。 本新种产于山西太原西山煤田太原组7号煤层煤核中。 2、平泉无被果孢（新种） Achlamydocarpon pingquanensis sp. nov 大孢子囊10.0－15.0 mm长，8.1 mm宽，3.0 mm 高。背腹扁，不具顶脊，两侧角明显，远轴端开口。壁复杂，分化为5层：最外层为薄壁细胞层，厚1-3层细胞;次外层为次生壁强烈增厚的细胞层，厚2-数层细胞;中层为具深色内含物的薄壁细胞层，厚2-数层细胞;次内层为与次外层相似的厚壁细胞层;内层为厚度达数个细胞的薄壁细胞层。孢子叶柄侧翼发育，宽度大于孢子囊宽度。背脊或龙骨很不显著。远轴面有时呈强烈的起伏不平状。大孢子囊底部与孢子囊柄连结部分由厚壁的细胞构成。不育组织垫结构较显著。功能大孢子扁缩，在近轴端发育较好，上表面具一突起结构。败育大孢子瘪缩，结构复杂，具明显肿块结构（？），瘤状肿块结构与败育孢子表面相连部分呈棒状。孢子叶柄近轴面不具有明显的厚壁组织区域;维管束由木质部束、维管束鞘及其所围成的空腔组成，但在远轴端仅剩下木质部束;通气组织发达，在维管束下方形成一独立空腔。 本新种分别产于山西太原西山煤田太原组7号煤层煤核和河北平泉杨树岭煤矿太原组火山凝灰岩中。 过渡无被果孢（新种）的特征介于欧美植物区的变异无被果孢类型和塔赫他间无被果孢类型之间。平泉无被果孢（新种）则与变异无被果孢类型较相近，但二者的大孢子囊壁的最外层完全不同：前者的是柱状细胞层，而后者的则由近等径的类似薄壁组织的细胞构成。二个未定种中，无被果孢（未定种 1）与过渡无被果孢（新种）很相似，区别在于前者的大孢子囊壁缺乏最外层的柱状细胞层以及孢子叶柄具明显的背脊或龙骨。无被果孢（未定种 2）则与塔赫他间无被果孢类型较接近。 根据华夏植物区和欧美植物区的化石材料和文献，探讨了保存不完整的大孢子囊-孢子叶复合体的远轴端和近轴端的判断方法：孢子囊较宽较高、孢子叶柄较为粗大、侧翼较发育、维管束较大、通气腔较发育的一端往往为远轴端，反之则为近轴端。 还讨论了无被果孢属一些构造的演化趋势： 1、孢子囊壁由简单向复杂或高度分化; 2、通气组织由不发达到高度特异化; 3、叶迹从微弱到显著，从简单到复杂; 4、败育大孢子从饱满到瘪缩，从表面平整到高度曲折，结构复杂化 5、大孢子四分体结合紧密度呈下降趋势

Smoothing a Discrete Hazard Function for the Number of Patients Colonized with Methicillin-Resistance Staphylococcus Aureus in an Intensive Care Unit

A new method for estimating the time to colonization of Methicillin-resistant Staphylococcus Aureus (MRSA) patients is developed in this paper. The time to colonization of MRSA is modelled using a Bayesian smoothing approach for the hazard function. There are two prior models discussed in this paper: the first difference prior and the second difference prior. The second difference prior model gives smoother estimates of the hazard functions and, when applied to data from an intensive care unit (ICU), clearly shows increasing hazard up to day 13, then a decreasing hazard. The results clearly demonstrate that the hazard is not constant and provide a useful quantification of the effect of length of stay on the risk of MRSA colonization which provides useful insight.

Longitudinal Student Evaluations of a Postgraduate Unit Using Importance-Performance Analysis

The Australian tourism tertiary education sector operates in a competitive and dynamic environment, which necessitates a market orientation to be successful. Academic staff and management in the sector must regularly assess the perceptions of prospective and current students, and monitor the satisfaction levels of current students. This study is concerned with the setting and monitoring of satisfaction levels of current students, reporting the results of three longitudinal investigations of student satisfaction in a postgraduate unit. The study also addresses a limitation of a university’s generic teaching evaluation instrument. Importance-performance analysis (IPA) has been recommended as a simple but effective tool for overcoming the deficiencies of many student evaluation studies, which have generally measured only attribute importance or importance at the end of a semester. IPA was used to compare student expectations of the unit at the beginning of semester with their perceptions of performance ten weeks later. The first stage documented key benchmarks for which amendments to the unit based on student feedback could be evaluated during subsequent teaching periods.

Staff perspectives of a cardiology short stay unit

Objective To evaluate staff perceptions about working environment, efficiency and the clinical safety of a cardiovascular intervention short stay unit (SSU) during the first year of operation. Design Postal questionnaire. Setting Cardiac catheterisation laboratory (CCL), coronary care unit (CCU), general cardiology ward (GCW) and the short stay unit (SSU) of a tertiary referral hospital situated in the mid coastal region of NSW. Subjects Cardiologists (including visiting medical officers [VMO]), cardiology fellows, cardiology advanced trainees and nurses. Results Responses on the working environment of the SSU and the discharge process were statistically significant. A substantial proportion of both nurses and doctors had concerns about patient safety, even though no adverse events were formally recorded in the database. Conclusions Though the participants of the survey agree on the efficiency of the SSU in providing beds to the hospital, they disagree on aspects that are important in the functioning of the SSU, including the working environment, patient selection and clinical safety. The results highlight potential issues that could be improved or addressed and are relevant to the rollout of SSUs across NSW.

Using a longitudinal model to estimate the effect of methicillin-resistant staphylococcus aureus infection on length of stay in an intensive care unit

Healthcare-associated methicillin-resistant Staphylococcus aureus(MRSA) infection may cause increased hospital stay or, sometimes, death. Quantifying this effect is complicated because it is a time-dependent exposure: infection may prolong hospital stay, while longer stays increase the risk of infection. We overcome these problems by using a multinomial longitudinal model for estimating the daily probability of death and discharge. We then extend the basic model to estimate how the effect of MRSA infection varies over time, and to quantify the number of excess ICU days due to infection. We find that infection decreases the relative risk of discharge (relative risk ratio = 0.68, 95% credible interval: 0.54, 0.82), but is only indirectly associated with increased mortality. An infection on the first day of admission resulted in a mean extra stay of 0.3 days (95% CI: 0.1, 0.5) for a patient with an APACHE II score of 10, and 1.2 days (95% CI: 0.5, 2.0) for a patient with an APACHE II score of 30. The decrease in the relative risk of discharge remained fairly constant with day of MRSA infection, but was slightly stronger closer to the start of infection. These results confirm the importance of MRSA infection in increasing ICU stay, but suggest that previous work may have systematically overestimated the effect size.

The Student Success Project : Helping students at-risk of failing or leaving a unit - a work in progress

In Semester 1 2007, a Monitoring Student Engagement study, conducted as part of the Enhancing Transition at Queensland University of Technology (ET@QUT) Project and extending earlier work in the Project by Arora (2006), aimed at mapping the processes and resources used at that time to identify, monitor and manage students in their first year who were at risk of leaving QUT (Shaw, 2007). This identified a lack of documentation of the processes and resources used and revealed an ad-hoc rather than holistic and systematic approach to monitoring student engagement. One of Shaw’s recommendations was to: “To introduce a centralised case management approach to student engagement” (p. 14). That provided the genesis for the Student Success Project that is being reported on here. The aim of the Student Success Project is to trial, evaluate and ultimately establish holistic and systematic ways of helping students who appear to be at-risk of failing or withdrawing from a unit to persist and succeed. Students are profiled as being at-risk if they are absent from more than 2 tutorials in a row without contacting their tutor or if they fail to submit their first assignment. A Project Officer makes personal contact with these students to suggest ways they can get further assistance depending on their situation.

Challenging endoscopy reprocessing guidelines: a prospective study investigating the safe shelf life of flexible endoscopes in a tertiary gastroenterology unit.

Professional prac− tice guidelines for endoscope reprocessing re− commend reprocessing endoscopes between each case and proper storage following repro− cessing after the last case of the list. There is lim− ited empirical evidence to support the efficacy of endoscope reprocessing prior to use in the first case of the day; however, internationally, many guidelines continue to recommend this practice. The aim of this study is to estimate a safe shelf life for flexible endoscopes in a high−turnover gastroenterology unit. Materials and methods: In a prospective obser− vational study, all flexible endoscopes in active service during the 3−week study period were mi− crobiologically sampled prior to reprocessing be− fore the first case of the day (n = 200). The main outcome variables were culture status, organism cultured, and shelf life. Results: Among the total number of useable samples (n = 194), the overall contamination rate was 15.5 %, with a pathogenic contamination rate of 0.5 %. Mean time between last case one day and reprocessing before the first case on the next day (that is, shelf life) was 37.62 h (SD 36.47). Median shelf life was 18.8 h (range 5.27± 165.35 h). The most frequently identified organ− ism was coagulase−negative Staphylococcus, an environmental nonpathogenic organism. Conclusions: When processed according to es− tablished guidelines, flexible endoscopes remain free from pathogenic organisms between last case and next day first case use. Significant re− ductions in the expenditure of time and resources on reprocessing endoscopes have the potential to reduce the restraints experienced by high−turnover endoscopy units and improve ser− vice delivery.

Cost effectiveness of antimicrobial catheters in the intensive care unit : Addressing uncertainty in the decision

Introduction: Some types of antimicrobial-coated central venous catheters (A-CVC) have been shown to be cost-effective in preventing catheter-related bloodstream infection (CR-BSI). However, not all types have been evaluated, and there are concerns over the quality and usefulness of these earlier studies. There is uncertainty amongst clinicians over which, if any, antimicrobial-coated central venous catheters to use. We re-evaluated the cost-effectiveness of all commercially available antimicrobialcoated central venous catheters for prevention of catheter-related bloodstream infection in adult intensive care unit (ICU) patients. Methods: We used a Markov decision model to compare the cost-effectiveness of antimicrobial-coated central venous catheters relative to uncoated catheters. Four catheter types were evaluated; minocycline and rifampicin (MR)-coated catheters; silver, platinum and carbon (SPC)-impregnated catheters; and two chlorhexidine and silver sulfadiazine-coated catheters, one coated on the external surface (CH/SSD (ext)) and the other coated on both surfaces (CH/SSD (int/ext)). The incremental cost per qualityadjusted life-year gained and the expected net monetary benefits were estimated for each. Uncertainty arising from data estimates, data quality and heterogeneity was explored in sensitivity analyses. Results: The baseline analysis, with no consideration of uncertainty, indicated all four types of antimicrobial-coated central venous catheters were cost-saving relative to uncoated catheters. Minocycline and rifampicin-coated catheters prevented 15 infections per 1,000 catheters and generated the greatest health benefits, 1.6 quality-adjusted life-years, and cost-savings, AUD $130,289. After considering uncertainty in the current evidence, the minocycline and rifampicin-coated catheters returned the highest incremental monetary net benefits of $948 per catheter; but there was a 62% probability of error in this conclusion. Although the minocycline and rifampicin-coated catheters had the highest monetary net benefits across multiple scenarios, the decision was always associated with high uncertainty. Conclusions: Current evidence suggests that the cost-effectiveness of using antimicrobial-coated central venous catheters within the ICU is highly uncertain. Policies to prevent catheter-related bloodstream infection amongst ICU patients should consider the cost-effectiveness of competing interventions in the light of this uncertainty. Decision makers would do well to consider the current gaps in knowledge and the complexity of producing good quality evidence in this area.

Methods and preliminary results for a data linkage project to determine long-term survival after intensive care unit admission

Aims: To describe a local data linkage project to match hospital data with the Australian Institute of Health and Welfare (AIHW) National Death Index (NDI) to assess longterm outcomes of intensive care unit patients. Methods: Data were obtained from hospital intensive care and cardiac surgery databases on all patients aged 18 years and over admitted to either of two intensive care units at a tertiary-referral hospital between 1 January 1994 and 31 December 2005. Date of death was obtained from the AIHW NDI by probabilistic software matching, in addition to manual checking through hospital databases and other sources. Survival was calculated from time of ICU admission, with a censoring date of 14 February 2007. Data for patients with multiple hospital admissions requiring intensive care were analysed only from the first admission. Summary and descriptive statistics were used for preliminary data analysis. Kaplan-Meier survival analysis was used to analyse factors determining long-term survival. Results: During the study period, 21 415 unique patients had 22 552 hospital admissions that included an ICU admission; 19 058 surgical procedures were performed with a total of 20 092 ICU admissions. There were 4936 deaths. Median follow-up was 6.2 years, totalling 134 203 patient years. The casemix was predominantly cardiac surgery (80%), followed by cardiac medical (6%), and other medical (4%). The unadjusted survival at 1, 5 and 10 years was 97%, 84% and 70%, respectively. The 1-year survival ranged from 97% for cardiac surgery to 36% for cardiac arrest. An APACHE II score was available for 16 877 patients. In those discharged alive from hospital, the 1, 5 and 10-year survival varied with discharge location. Conclusions: ICU-based linkage projects are feasible to determine long-term outcomes of ICU patients