Endogenous post-stratification in surveys classifying with a sample-fitted model
胞内寄生菌对巨噬细胞免疫逃逸的研究进展
胞内寄生菌对巨噬细胞免疫逃逸的研究进展①田丽吴显伟周伟张惠勇张少言鹿振辉(上海中医药大学附属龙华医院,上海 200030)中图分类号R392.12 文献标志码 A 文章编号1000-484X(2023)10-2086-06[摘要]病原微生物在感染宿主后,巨噬细胞作为主要的免疫哨兵细胞首先识别并吞噬入侵的病原体,而入侵的病原体可发展多种策略逃避巨噬细胞杀伤,并适应宿主细胞内环境,在胞内复制和存活。
现对胞内感染常见细菌和真菌对巨噬细胞免疫逃逸的策略进行概述。
[关键词]胞内寄生菌;固有免疫;巨噬细胞;免疫逃逸Advances in study of immune escape of macrophages by intracellular parasitic bacteriaTIAN Li, WU Xianwei, ZHOU Wei, ZHANG Huiyong, ZHANG Shaoyan, LU Zhenhui. Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200030, China[Abstract]Following infection of host by pathogenic microorganisms, macrophages serve as primary immune sentinel cells to first recognize and engulf invading pathogens, while invading pathogens can develop multiple strategies to escape macrophage killing and adapt to intracellular environment of host to replicate and survive intracellularly. Here is a brief overview of immune escape strate‑gies of bacteria and fungi common to intracellular infections against macrophages.[Key words]Intracellular parasitic bacteria;Intrinsic immunity;Macrophages;Immune escape病原微生物侵袭机体后,机体内固有免疫系统首先启动。
脑卒中患者血清VILIP-1、PRDX1、Pannexin1表达水平及其与预后的关系
脑卒中患者血清VILIP-1、PRDX1、Pannexin1表达水平及其与预后的关系郝井志1,王瑞2,刘晓琳2延安大学咸阳医院脑血管病研究所1、检验科2,陕西咸阳721000【摘要】目的探讨脑卒中患者血清视锥蛋白样蛋白-1(VILIP -1)、过氧化还原蛋白1(PRDX1)、泛连接蛋白1(Pannexin1)的表达水平对预后的影响。
方法选取2020年1月至2022年3月延安大学咸阳医院脑血管病研究所诊治的110例脑卒中患者作为观察组,并选择同期我院120例身体健康的体检者作为对照组,比较观察组与对照组,观察组不同病情、不同预后患者的血清VILIP -1、PRDX1、Pannexin1水平,并采用多因素Logistic 回归分析影响脑卒中患者预后的危险因素。
结果观察组患者的VILIP -1、PRDX1、Pannexin1水平分别为(9.17±1.18)ng/mL 、(9.30±1.83)ng/mL 、(5.37±0.80)mg/mL ,明显高于对照组的(3.10±0.60)ng/mL 、(3.66±0.78)ng/mL 、(2.02±0.61)mg/mL ,差异均有统计学意义(P <0.05);随着脑卒中患者病情的严重程度加重,血清VILIP -1、PRDX1、Pannexin1表达水平均逐渐升高,其中重度组明显高于中度和轻度组,中度组明显高于轻度组,差异均有统计学意义(P <0.05);预后良好组患者的VILIP -1、PRDX1、Pannexin1水平分别为(4.69±0.81)ng/mL 、(7.46±1.68)ng/mL 、(4.95±1.13)mg/mL ,明显低于预后不良组的(7.98±1.25)ng/mL 、(12.01±1.93)ng/mL 、(6.14±1.29)mg/mL ,差异均有统计学意义(P <0.05);预后良好组患者的高血压、糖尿病、冠心病、高同型半胱氨酸、高脂血症、吸烟、酗酒的发生率明显低于预后不良组,差异均有统计学意义(P <0.05);经多因素Logistic 回归性分析结果显示,血清VILIP -1、PRDX1、Pannexin1均是影响脑卒中患者预后的危险因素(P <0.05)。
Caprini血栓风险评估量表简介
Caprini血栓风险评估量表简介发布时间:2013-06-04 15:07:42所属栏目:指南与共识四川大学华西医院呼吸科陈启敏周海霞易群摘要:静脉血栓栓塞症(VTE)包括深静脉血栓(DVT)和肺血栓栓塞(PTE),因“发病率高、死亡率高、漏诊率高”已成为世界性的公共健康医疗保健问题;但同时,这一疾病也被认为是“最有可能预防的一种致死性疾病”。
Caprini血栓风险评估量表是一个个体化的VTE风险评估量表,它根据一系列先天性和/或获得性危险因素对患者进行评分,据此将患者分为低危、中危、高危、极高危四类,并推荐相应的预防措施。
在西方发达国家的相关验证研究已表明该量表的有效性,其在中国也有很好的应用前景,本文将对该量表进行一个简要介绍。
关键词:静脉血栓栓塞症;深静脉血栓;肺血栓栓塞;caprini血栓风险评估量表;预防1.静脉血栓栓塞症概述概念静脉血栓栓塞症(venous thromboembolism, VTE):指血液在静脉内不正常地凝结,使血管完全或不完全阻塞,属静脉回流障碍性疾病。
包括两种类型:深静脉血栓形成(deep vein thrombosis, DVT)和肺血栓栓塞症(pulmonary thromboembolism, PTE),即静脉血栓栓塞症在不同部位和不同阶段的两种临床表现形式。
深静脉血栓形成(DVT):约占VTE的三分之二,可发生于全身各部位静脉,以下肢深静脉为多,临床上常无症状。
下肢近端(腘静脉或其近侧部位)深静脉血栓形成是肺栓塞血栓栓子的主要来源,预防深静脉血栓形成可降低肺血栓栓塞症的风险。
肺血栓栓塞症(PTE):指来自静脉系统或右心的血栓阻塞肺动脉或其分支导致的肺循环和呼吸功能障碍疾病,是导致住院患者死亡的重要原因之一。
据报道10%的院内死亡为PTE所致所有入院患者中有1% 死于PTE[1-3]。
由于PTE与DVT在发病机制上存在相互关联,两者是同一疾病在不同部位的表现,也是同一疾病的不同阶段, 因此统称为静脉血栓栓塞症(VTE)。
消化专科护理在金属钛夹治疗消化道溃疡出血中的应用
护理论著CHINESE COMMUNITY DOCTORS 消化道出血是临床常见急症之一,精心专业的护理及与医生密切有效的配合,能够提高内镜下治疗上消化道出血的成功率,为缩短患者治疗时间,快速有效地达到治疗目的,减轻疾病带来的痛苦[1]。
临床资料收治消化道出血患者85例,男40例,女45例;年龄20~65岁,十二指肠球部溃疡30例,胃溃疡28例,糜烂出血性胃炎27例,均为初次出血,病情危重,短时间出血量预计>250~300mL,或出现心率、血压变化等循环障碍表现,经临床评估符合急诊内镜止血指征,给予急诊内镜下止血治疗[2]。
护理术前护理:突发呕血或黑便经常会引起患者情绪紧张、恐惧,护士应及时迅速地清理其呼吸道、床单位的血迹,减少不良情绪产生。
遵医嘱给予患者止血、抑酸剂及黏膜保护剂,必要时建立双静脉通路给予补充血容量维持循环支持治疗。
给予患者心电血压监测,密切观察生命体征变化。
嘱患者禁食水,避免呕吐时误吸,亦避免食物摩擦加重出血。
详细了解患者既往病史、判断其是否具有操作禁忌证。
医护人员耐心向患者及家属讲解止血治疗的必要性,且内镜下止血术是最快速有效的治疗方法,介绍操作步骤及止血效果,消除患者紧张焦虑的情绪,帮助患者建立信心,取得配合。
经患者及家属同意后,签好知情同意书。
术中医护配合:消化专科护理人员作为助手在操作过程中起着非常重要的作用[3]。
护士在操作前仔细检查核对术中所需的器械种类、数量、消毒是否合格。
保证所需的消化内镜仪器线路及管道连接完好,功能正常,确保内镜止血治疗过程能够顺利进行。
遵医嘱备齐抢救药品及常规止血药,给予患者心电血压监护,密切观察生命体征,持续氧气吸入,保证静脉通路通畅。
术前给予患者解痉镇静剂(必要时),并口服2%利多卡因胶浆10mL,嘱患者口含2min 后缓慢咽下,充分麻醉咽喉部,以预防术中出现恶心、呕吐。
操作配合中要保证动作迅速、轻柔和熟练,减少患者治疗时的痛苦。
协助患者于治疗床取左侧卧位,双膝弯曲,嘱患者全身放松,注意防止坠床。
《2023年美国肝病学会实践指南:+肝硬化门静脉高压和静脉曲张的风险分层及管理》摘译
《2023年美国肝病学会实践指南:肝硬化门静脉高压和静脉曲张的风险分层及管理》摘译雒博晗,韩国宏西安国际医学中心医院消化内科,西安 710100通信作者:韩国宏,139****************(ORCID: 0000-0003-4568-3776)摘要:本实践指南旨在整合最佳实践建议,用于在慢性肝病患者中识别门静脉高压、预防首次肝功能失代偿、管理急性静脉曲张出血以及降低静脉曲张再出血的风险。
该指南中最重要的变化涉及承认代偿期进展性慢性肝病的概念,使用无创评估识别临床有意义的门静脉高压,在发现门静脉高压时建议尽早使用非选择性β-受体阻滞剂,进一步探讨门静脉高压的潜在未来药物治疗选择,阐明优先经颈静脉肝内门体静脉分流术在急性静脉曲张出血中的作用,以及讨论胃底静脉曲张治疗相关的最新数据,并提出了新的主题,如门静脉高压性胃病、经食管超声心动图和抗肿瘤治疗前的内窥镜检查。
关键词:肝硬化;门静脉高压;食管和胃静脉曲张;美国An excerpt of AASLD practice guidance on risk stratification and management of portal hypertension and varices in cirrhosis (2023)LUO Bohan, HAN Guohong.(Department of Gastroenterology, Xi’an International Medical Center Hospital, Xi’an 710100, China)Corresponding author: HAN Guohong,139****************(ORCID: 0000-0003-4568-3776)Abstract:This Practice Guidance intends to coalesce best practice recommendations for the identification of portal hypertension (PH),for prevention of initial hepatic decompensation,for the management of acute variceal hemorrhage (AVH),and for reduction of the risk of recurrent variceal hemorrhage in chronic liver disease. The most significant changes in the current Guidance relate to recognition of the concept of compensated advanced chronic liver disease, codification of methodology to use noninvasiveassessments to identify clinically significant PH (CSPH), and endorsement of a change in paradigm with the recommendation of early utilization of nonselective beta-blocker therapy when CSPH is identified. The updated guidance further explores potential future pharmacotherapy options for PH,clarifies the role of preemptive transjugular intrahepatic portosystemic shunt in AVH,discusses more recent data related to the management of cardiofundal varices, and addresses new topics such as portal hypertensive gastropathy and endoscopy prior to transesophageal echocardiography and antineoplastic therapy.Key words:Liver Cirrhosis; Portal Hypertension; Esophageal and Gastric Vorrices; United States本实践指南[1]更新并扩展了美国肝病学会(AASLD)于2017年发布的门静脉高压(portal hypertension,PH)和胃食管静脉曲张管理的实践指南,为预防和管理PH提供了数据支持。
抗老与死亡英语作文
抗老与死亡英语作文英文回答:Aging is an inevitable process that all living organisms undergo. It is characterized by a decline in physiological functions and an increased susceptibility to death. The hallmarks of aging include cellular senescence, mitochondrial dysfunction, genomic instability, loss of proteostasis, and epigenetic alterations. These changes lead to a progressive decline in the ability of cells to repair and regenerate, resulting in tissue and organ dysfunction and ultimately death.The process of aging is influenced by both genetic and environmental factors. Genetic factors include mutations in genes involved in DNA repair, mitochondrial function, and cellular stress response. Environmental factors include exposure to toxins, radiation, and oxidative stress. These factors can accelerate the aging process and increase the risk of age-related diseases.There is no known cure for aging, but there are a number of interventions that can slow down the aging process and extend lifespan. These interventions include calorie restriction, exercise, and antioxidant supplementation. Calorie restriction has been shown to extend lifespan in a variety of animal models, and it is thought to work by reducing oxidative stress and inflammation. Exercise has also been shown to have anti-aging effects, and it is thought to work by improving mitochondrial function and reducing inflammation. Antioxidant supplementation can help to protect cells from damage caused by free radicals, and it has been shown to extend lifespan in some animal models.Although there is no way to completely prevent aging, there are a number of things that can be done to slow down the aging process and extend lifespan. These interventions can help to improve overall health and well-being, and they may also reduce the risk of age-related diseases.中文回答:衰老。
商务英语词汇-医学寄生虫学英语词汇翻译_外贸商务英语四级六级
商务英语词汇 - 医学寄生虫学英语词汇翻译_外贸商务英语四级六级考研雅思英语翻译写作作文听力单词在线字典,learn english dictionary,spkcn首页英语听力词汇学习英语童话英语演讲 ESL资源 Delphi 站内搜索联系我们设为首页您的位置:商务英语词汇 > 医药卫生 > 医学寄生虫学英语词汇翻译医学寄生虫学英语词汇翻译2006-09-27 spkcn 点击: 14Medical Parasitology 医学寄生虫学Aedes 伊蚊alternation of generations 世代交替amastigote 无鞭毛体AmoebiasisAncylostoma duodenale 十二指肠钩口线虫Anopheles 按蚊ascariasis 蛔虫病ascaris lumbricoides 似蚓蛔线虫arthropod 节肢动物bradysporozoite 迟发型子孢子bradyzoite 缓殖子Brugia malayi 马来布鲁线虫capsule 荚膜,被膜,囊胞carrier 携带者,载体,载流子,带虫者cercaria 尾蚴cercarial dermatitis 尾蚴性皮炎daughter cyst 子囊ectopic parasitism 异位寄生egg 卵elephantiasis 象皮肿enterobiasis 蛲虫病Enterobius vermiculariserythrocytic stage 红细胞内期facultative parasite 兼性寄生虫fasciolopsiasisfasciolopsis buskifertile egg 受精卵filaria 丝虫filariasis 丝虫病filariform larvae 丝状蚴final host 终宿主flea 蚤fly 蝇gametocyte 配子体Giardia lamblia 蓝氏贾第鞭毛虫Giardiasis 贾第虫病gravid proglottid 孕节helminth 蠕虫helminthiasis 蠕虫病hemimetabola 不全变态hexacanth 六钩蚴hookworm disease 钩虫病host 宿主human parasitology 人体寄生虫学hydatid cyst 棘球蚴囊hydatid diseaseimmature proglottid 幼节immune evasion 免疫逃避infective stage 感染阶段infertile cyst 不育囊larva 幼虫larva migrans 幼虫移行症Leishmania donovani 杜氏利什曼原虫Leishmaniasis 利什曼病life cycle 生活史louse 虱macrogametocyte 大配子体malaria 疟疾malaria pigment 疟色素mature proglottid 成节medical arthropodology 医学节肢动物学merozoite 裂殖子metacercaria 囊蚴microfilaria 微丝蚴microgametocyte 雄配子体,小配子体miracidium 毛蚴mosquito 蚊myiasis 蛆病Necator americanus 美洲板口线虫Nematode 线虫nocturnal periodicity 夜现周期性nymph 若虫obligatory parasite 专性寄生虫onchosphere 六钩蚴oocyst 卵囊ovum 卵,卵细胞Pagumogonimus skrjabini 斯氏狸殖吸虫paragonimiasis 肺吸虫病parasite 寄生虫parasitic zoonosis 人兽共患寄生虫parasitism 寄生paratenic host (transport host) 转续宿主plerocercoid (sparganum) 裂头蚴Pneumocystis carinii 卡氏肺孢子虫premunition 带虫免疫procercoid 原尾蚴promastigote 前鞭毛体protoscolex 原头蚴protozoon (protozoa) 原生动物pseudocyst 假包囊pupa 蛹recrudescence 再燃redia 雷蚴relapse 复发reservoir host 保虫宿主sandfly 白蛉sarcoptes mites 疥螨Sarcoptes scabiei 人疥螨scabies 疥疮Schistosoma haematobium 埃及血吸虫Schistosoma japomicum 日本血吸虫Schistosoma mansoni 曼氏血吸虫Schistosomiasis 血吸虫病schistosomule (schistosomula) 童虫schizont 裂殖体Schuffners dots 薛氏小点scolex 头节soft ticks 软蜱somatic antigen 虫体抗原sparganosis 裂头蚴病Spirometra mansoni 曼氏迭宫绦虫sporocyst 胞蚴sporozoite 子孢子sterilizing immunity 消除性免疫surface antigen 表面抗原tachysporozoite 速发型子孢子tachyzoite 速殖子taeniasis 带绦虫病tapeworm 绦虫Copyright © 2005-2010 商务英语词汇, Inc. All Rights Reserved.版权声明:未经本站许可,任何人不得复制本站内容。
颈动脉慢性完全闭塞后再通的症状英文
69%
Distal protection device used after crossing
27
73%
PercuSurge/FilterWire
17/10
63%/37%
Post-dilatation balloon diameter (mm)
In-hopsital , n (%)
3-m follow-up, n (%)
Death
1 (1.9)
1 (1.9)
Fatal stroke
1 (1.9)
1 (1.9)
Other cause
0
0
Stroke
2 (3.7)
2 (3.7)
Major ipsi.
0
0
Major non-ipsi.
35
65%
Lesion location, right/left
27/27
50%/50%
CCA diameter (mm)
7.9±0.6
ICA diameter (mm)
5.1±0.5
Occlusion length (mm)
27.9±16.2
Wire crossing successful
Paul HL Kao 08
Prognosis and pathophysiology of ICAO
Cervical ICAO is an important cause of TIA and cerebral infarction and should not be neglected Annual risk of ipsilateral stroke in symptomatic ICAO is 6-20% Annual risk of ipsilateral stroke in asymptomatic ICAO is 2-5 % Pathophysiology of symptoms Emboli arising from ECA/CCA via collaterals Emboli arising from ICA stump via collaterals (Stump syndrome) Emboli arising from trailing thrombi distal to the occlusion Hypo-perfusion (hemodynamic insufficiency)
急性心肌梗死后延迟支架植入的临床研究进展
急性心肌梗死后延迟支架植入的临床研究进展高旸*杨继娥*张峰**(复旦大学附属中山医院心内科上海 200032)摘要急性心肌梗死患者接受直接经皮冠状动脉介入治疗植入支架后的微血管栓塞和无复流现象一直是影响患者预后的主要因素之一。
延迟支架植入是降低支架植入后微血管阻塞和无复流风险的方法之一,其与强化抗血栓药物治疗相结合,能减轻急性心肌梗死患者的血栓负荷,降低短期血管造影检查事件的发生率。
然而,多项随机、对照研究和荟萃分析都未能证实该方法对急性心肌梗死患者的长期死亡率、主要心血管不良事件发生率和其他临床终点有改善作用,因此临床上对延迟支架植入是否有益还存在争议。
延迟支架植入的应用也受到新一代药物洗脱支架得到广泛应用的限制,需有更多的临床研究证实延迟支架植入在特殊的急性心肌梗死患者亚群中的安全性和有效性。
关键词急性心肌梗死 直接经皮冠状动脉介入治疗延迟支架植入中图分类号:R542.22;R654.3文献标志码:A 文章编号:1006-1533(2019)01-0008-04Deferred stent implantation for acute myocardial infarction:a review of recent studiesGAO Yang*, YANG Ji’e*, ZHANG Feng**(Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China) ABSTRACT Microvascular obstruction and no-reflow after stent implantation in patients presenting with acute myocardial infarction and undergoing primary percutaneous coronary intervention are strong predicting factors of adverse events and unfavorable prognosis, especially when it comes to patients with greater age, longer occlusion or strong thrombus burden. To deal with this situation, some specialists come up with a deferred stent implantation method. Deferred stent implantation with adjunctive antithrombotic therapy is an effective method to alleviate the thrombus burden, partially restore vascular function and reduce the risks of microvascular obstruction, no-reflow phenomena and short-term angiographic events. However, several randomized controlled trials and related meta-analysis indicate that deferred stent implantation did not reduce mortality, major adverse cardiac events or other severe clinical outcome. The advantage of deferred stent implantation is in controversy and its application is limited due to the widespread usage of second-generation drug-eluting stents. More clinical trials are necessary to confirmed the effect and safety of deferred stent implantation on specific subgroup of patients with acute myocardial infarction.KEy WORDS acute myocardial infarction; primary percutaneous coronary intervention; deferred stent implantation在急性心肌梗死的直接经皮冠状动脉介入治疗(primary percutaneous coronary intervention, PPCI)中,成功恢复血流后植入支架已成为常规治疗方法。
地诺孕素用于子宫内膜异位症保守术后维持治疗的Meta分析
地诺孕素用于子宫内膜异位症保守术后维持治疗的Meta 分析黄婷,黄高廷,杨国敏,梁梦姗,朱耀魁【摘要】目的:比较地诺孕素与其他治疗方法在预防腹腔镜下子宫内膜异位症(EMs )保守术后复发的有效性及安全性,从而为临床上药物的选择提供参考依据。
方法:检索PubMed 、Embase 、Cochrane Library 、Web of Science 、Clini - 、中国知网、万方及维普数据库自建库至2020年4月的相关文献和试验,检索的文献由两名评价人员独立筛选、质量评价以及数据提取,最终纳入的数据使用Revman 5.3进行Meta 分析。
结果:最终纳入10篇文献,共1740例患者。
Meta 分析结果显示,地诺孕素较期待治疗的病灶复发风险低(OR=0.11,95%CI :0.07~0.19,P <0.00001),并能缓解EMs 相关疼痛;地诺孕素与促性腺激素释放激素激动剂(GnRHa )治疗相比,病灶复发风险(OR=0.49,95%CI :0.19~1.24,P=0.13)及疼痛缓解情况(P >0.05)差异无统计学意义,地诺孕素治疗后阴道出血(RR =13.11,95%CI :5.02~34.21,P <0.00001)发生风险较高,潮热发生风险较低(RR =0.12,95%CI :0.06~0.26,P <0.00001),差异有统计学意义,头痛(RR =3.49,95%CI :0.99~12.25,P=0.05)发生风险较高,但差异无统计学意义;地诺孕素与左炔诺孕酮宫内缓释系统(LNG-IUS )治疗相比,病灶复发风险差异无统计学意义(OR=0.46,95%CI :0.50~1.04,P=0.06),地诺孕素能有效缓解EMs 相关疼痛(SMD =-0.46,95%CI :-0.70~-0.22,P=0.0001),地诺孕素治疗后发生阴道出血(OR=0.38,95%CI :0.18~0.81,P=0.01)、阴道分泌物增加(OR=0.03,95%CI :0.00~0.48,P=0.01)及同房不适(OR=0.04,95%CI :0.00~0.70,P=0.03)的风险相对较低;与米非司酮相比,地诺孕素能降低病灶复发风险(OR=0.41,95%CI :0.18~0.96,P=0.04),且缓解疼痛的疗效相对较好(OR=21.00,95%CI :2.65~166.45,P=0.004),地诺孕素发生潮热的风险较低(OR=0.11,95%CI :0.01~0.89,P=0.04)。
有关强迫症囤积症的英语作文
The Complexities of Compulsive Hoarding: A Deep Dive into the DisorderObsessive-compulsive hoarding disorder (OCDH) is a complex psychological condition that significantly impacts the lives of those affected. Characterized by the uncontrollable urge to acquire and retain a large number of possessions, regardless of their actual value or utility, OCDH often leads to significant clutter and disorganization in the home and workspace. This disorder goes beyond mere cluttering and can significantly interfere with daily activities, social interactions, and overall well-being.At the heart of OCDH lies a deep-seated anxiety and fear of discarding items, even those that are no longer useful or wanted. This anxiety is often rooted in a belief that the items may be needed in the future or could hold some emotional value, even if that value is difficult to articulate. The result is a constant accumulation of items, leading to a sense of overwhelming chaos and lack of control.The impact of OCDH is far-reaching. It can lead to significant stress and anxiety for the individual,affecting their ability to function normally in daily life. It can strain relationships with family and friends, who may feel overwhelmed by the clutter and disorganization. It can also pose a safety hazard, with the potential for trips, falls, and other accidents due to the accumulation of items. Treating OCDH is challenging but crucial. Therapy, particularly cognitive-behavioral therapy (CBT), can help individuals identify and address the underlying anxieties and beliefs that drive the hoarding behavior. Medication may also be prescribed to help manage symptoms such as anxiety and depression. However, the most effective treatment often involves a combination of therapy and medication, along with the support and understanding of loved ones.In conclusion, OCDH is a complex disorder that requires a multifaceted approach to treatment. By understanding the underlying anxieties and beliefs that drive the behavior, individuals can take steps to manage their symptoms and improve their overall quality of life. With the support and understanding of loved ones, those affected by OCDH canbegin to overcome the challenges of this disorder and move towards a more organized and fulfilling life.**强迫症囤积症的复杂性:深入探索这种心理疾病** 强迫症囤积症(OCDH)是一种复杂的心理疾病,严重影响了受影响者的生活。
有关强迫症囤积症的英语作文
有关强迫症囤积症的英语作文Obsessive-Compulsive Disorder (OCD) is a mental health condition that affects millions worldwide, characterized by recurring thoughts and behaviors. One of its forms, hoarding, can significantly impact a person's life.Hoarding, a subset of OCD, involves an intense urge to collect and keep items, regardless of their value or usefulness. This compulsion often stems from a fear of losing something important or a belief that the items will be needed in the future.The consequences of hoarding can be severe, leading to cluttered living spaces that pose health and safety risks. It can also strain relationships, as family and friends may struggle to understand the individual's inability to part with items.Treatment for hoarding typically involves a combination of therapy and medication. Cognitive-behavioral therapy, in particular, has shown promise in helping individuals recognize and change their hoarding behaviors.Support from loved ones is crucial in the recovery process. Understanding and patience can make a significant difference for someone battling hoarding tendencies.Raising awareness about hoarding and OCD is essential toreduce the stigma and encourage those affected to seek help. It's important to approach the topic with empathy and recognize that it is a complex mental health issue, not a simple lack of organization.In conclusion, hoarding is a deeply ingrained behavior that requires professional intervention and support from the community. By understanding its roots and the challenges it presents, we can better assist those who are affected by this condition.。
晚期创伤生命支持的创伤
1/00
7
B. Breathing &Ventilation
* Airway patency does not assure adequate v e n t i l a t i o n .
C. Circulation with HemorrhageControl.
1 . Blood Volume &Cardiac Output a. level of consciousness. b. skin color c. Pulse.
1/00
17
5. Abdomen *excessive manipulation of the pelvic should be avoided.
1/00
16
2. Maxillofacial Injury no NGtube, d e f i n i t e airway?
3. Cervical Spine & Neck
*Pt with maxillofacial or head trauma should be presumed t o have and unstable cervical spine.
Simple Mnemonic t o describe l eve l of consciousness A: alert V: Responds t o Vocal stimuli P : Responds t o Painful stimuli U: Unresponsive to a l l stimuli
*Blood a t the penile meatus
*Perineal ecchymosis
*Blood in the scrotum
医学专题指非外伤性脑实质内出血
第二十一页,共六十页。
Clinical features lobar hemorrhage
Etiology:AVM、Moyamoya disease、cerebral amyloid angiopathy、tumor
Hypertensive hemorrhages also occur in subcortical white matter underlying the frontal,parietal, temporal, and
少见,仅见脑膜刺激征
第十七页,共六十页。Fra bibliotekClinical features pontine hemorrhage
With bleeding into the pons(figure 3), coma occurs within seconds to minutes and usually leads to death within 48 hours.
第十五页,共六十页。
Clinical features basal ganglion hemorrhage
Aphasia may occur if hemorrhage at either site exerts pressure on the cortical language areas.
Large hemorrhages may lead to consciousness disturbance, while minor hemorrhages lead to lacunar syndrome.
Ocular findings typically include pinpoint pupils. Horizontal eyes movements are absent or impaired, but vertical eye movements may be preserved. In some patients, there may be ocular bobbing.
硬脑膜增厚 英语
硬脑膜增厚英语The thickening of the dura mater, also known as pachymeningitis, is a medical condition that can have various causes and implications. The dura mater is the tough, outermost membrane that surrounds the brain andspinal cord, providing protection and support. When it becomes thickened, it can lead to a range of symptoms and complications.One common cause of dural thickening is chronic inflammation, which can be the result of infections, autoimmune disorders, or other underlying health conditions. In some cases, trauma or injury to the head or spine can also lead to thickening of the dura mater. Additionally, certain tumors or growths within the skull or spinal canal can put pressure on the dura mater, causing it to thicken.Symptoms of dural thickening can vary depending on the underlying cause and the extent of the thickening. Some common symptoms include headaches, dizziness, nausea, and visual disturbances. In more severe cases, patients may experience seizures, weakness or numbness in the limbs, or changes in mental status.Diagnosing dural thickening typically involves a combination of imaging studies, such as MRI or CT scans, and possibly a biopsy to determine the underlying cause. Once a diagnosis is made, treatment will depend on the specific cause of the thickening. This may include medications to reduce inflammation, surgery to remove any tumors or growths, or other interventions to address the underlying condition.In some cases, dural thickening may not cause any symptoms and may be discovered incidentally during imaging studies for other reasons. In these situations, close monitoring and follow-up with a healthcare provider may be recommended to ensure that the thickening does not progress or cause any complications.Overall, dural thickening is a complex medical condition that requires careful evaluation and management. By understanding the underlying cause and addressing it appropriately, healthcare providers can help patients with this condition achieve the best possible outcomes.硬脑膜增厚是一种医学状况,可能有各种原因和含义。
医学英语表示疾病的后缀
病=六指畸形
-pathy/-pathia disease 病
• laryngopathy=laryngo+pathy=喉+病=喉 病
• mastopathy=masto+pathy=乳腺+病=乳 腺病
• arthropathia=arthro+pathia=关节+病= 关节病
• hyaloma=hyal+oma=透明+瘤=透明样瘤 • syndesmoma=syndesm+oma=结缔组织+
瘤=结缔组织瘤 • mastoncus=mast+oncus=乳腺+瘤=乳腺
瘤
-emia blood condition 血症
• gonococcaemia=gono+cocca+emia=淋病 +球菌+血症=淋球菌血症
肛门麻痹 喉病 直肠下垂 乳腺出血 尿酸血症 呕血
Thank you!
• proctectasis=proct+ectasis=直肠 +扩张=直肠扩张
-osis -ia /
abnormal condition
病,状态,症
• blennosis=blenn+osis=粘膜+病=粘膜病
• ketosis=ket+osis=酮+病=酮中毒病
• mastosis=mast+osis=乳腺+病=乳腺病
-crisis dangerous situation 危象
laryngocrisis=laryngo+crisis=喉+危象=喉危 象
促肾上腺皮质激素非依赖性库欣综合征术后激素替代治疗的研究
促肾上腺皮质激素非依赖性库欣综合征术后激素替代治疗的研究郭旭东,王翰博,任祥斌,金讯波,蒋绍博(山东大学附属省立医院 泌尿微创中心,济南 250014)基金支持:2012年山东省科技发展计划项目(2012GGB14030)通讯作者:蒋绍博 E-mail :********************【摘要】 目的 探讨促肾上腺皮质激素(adrenocorticotropic hormone ,ACTH )非依赖性库欣综合征患者术后激素替代治疗的方案及效果。
方法 选取本院2010年2月至2014年2月收治的ACTH 非依赖性库欣综合征患者52例为研究对象,其中单侧肾上腺腺瘤47例,行单侧肾上腺切除术;双侧肾上腺大结节样增生5例,行一侧肾上腺切除+对侧次全切除术。
围术期常规予以简化的激素替代治疗方案:术中静脉给予甲泼尼龙80 mg ,术后1~3天静脉给予甲泼尼龙60、40、20 mg ,术后第4天改为口服泼尼松片20 mg ,每周递减5 mg 直至维持剂量。
结果 截至本次随访周期,47例单侧肾上腺切除患者中42例停止激素替代治疗,平均替代治疗时间为6.5个月(3~15个月),5例双侧肾上腺手术患者中3例停止激素替代治疗,平均替代治疗时间为32个月(22~47个月)。
结论 简化的激素替代治疗方案能有效避免激素撤退综合征的发生,是ACTH 非依赖性库欣综合征患者术后激素替代治疗简单和有效的方法。
【关键词】 促肾上腺皮质激素非依赖性库欣综合征;激素替代治疗;肾上腺腺瘤;肾上腺大结节样增生Research on steroid replacement in patients with adrenocorticotropic hormone independent Cushing's syndrome after adrenalectomyGUO Xu-dong, WANG Han-bo, REN Xiang-bin, JIN Xun-bo, JIANG Shao-bo (Department of Minimally Invasive Urology, Provincial Hospital Affiliated to Shandong University, Jinan 250014, China)Correspondingauthor:JIANGShao-bo,E-mail:********************【Abstract 】 Objective To investigate the method and effect of steroid replacement following adrenalectomy in patients with adrenocorticotropic hormone (ACTH) independent Cushing's syndrome. Method From February 2010 to February 2014, a total of 52 cases of ACTH independent Cushing’s syndrome patients were received in our department. Among these cases, 47 cases were unilateral adenoma and underwent unilateral laparoscopic adrenalectomy, the rest 5 cases macronodular adrenal hyperplasia (AIMAH) underwent unilateral adrenalectomy and contralateral subtotal adrenalectomy. The brief postoperative steroid replacement was used, 80 mg methylprednisolone was given during operation, then 60 mg, 40 mg, 20 mg on the next three days. Oral prednisolone (20 mg) was used instead of intravenous drug from the 4th day, followed by a reduction of 5 mg every week until a maintenance dosage (5~10 mg) was reached. Result Among 47 cases of unilateral adenoma, 42 patients finished steroid replacement with a mean time of 6.5 (3~15) months. Among 5 cases of AIMAH, 3 patients finished steroid replacement with a mean time of 32 (22~47) months. Conclusion The brief postoperative steroid replacement can effectively avoid the occurrence of steroid withdrawal syndrome, is a brief and effective method for patients with ACTH independent Cushing's Syndrome.【Key words 】ACTH independent Cushing's syndrome; Steroid replacement; Adenoma; Macronodular adrenal hyperplasia库欣综合征是一种因肾上腺皮质分泌过量内源性皮质醇引起的一系列以向心性肥胖、满月脸、多血质外貌、皮肤紫纹、高血压、继发性糖尿病和骨质疏松症等为主要表现的临床综合征,分为促肾上腺皮质激素(adrenocorticotropic hormone ,ACTH )依赖性和非依赖性两大类[1]。
子宫内膜间质肉瘤术后发现胎盘部位滋养细胞肿瘤一例临床分析
子宫内膜间质肉瘤术后发现胎盘部位滋养细胞肿瘤一例临床分析发表时间:2016-05-13T11:23:47.857Z 来源:《名医》(学术版)2016年第2期作者:陶红艳[导读] ESS是一种少见的子宫恶性肿瘤,易局部复发和远处转移,多数复发发生在盆腹腔内,少数可发生于肺部及阴道。
手术是目前治疗ESS的主要方法,当怀疑远处转移病变时需排除其他疾病后在考虑选择合适、敏感的化疗方案。
陶红艳湖北省宜城市人民医院妇产科 441400[摘要]目的: 分析子宫内膜间质肉瘤(Endometrial stromal sarcomas ESS)的临床治疗特点。
方法: 结合一例子宫内膜间质肉瘤患者术后2年发现双肺结节经病理证实为胎盘部位滋养细胞肿瘤的临床资料进行分析。
结论: ESS是一种少见的子宫恶性肿瘤,易局部复发和远处转移,多数复发发生在盆腹腔内,少数可发生于肺部及阴道。
手术是目前治疗ESS的主要方法,当怀疑远处转移病变时需排除其他疾病后在考虑选择合适、敏感的化疗方案。
[关键词] 子宫内膜间质肉瘤;胎盘部位滋养细胞肿瘤;临床分析。
子宫内膜间质肉瘤(ESS)是一组临床少见的女性生殖器官恶性肿瘤,占所有妇科恶性肿瘤的0.2%,占子宫肉瘤的6%-20%【1-2】。
ESS在未绝经期妇女中较为多发,平均发病年龄在40岁左右。
ESS临床表现特异性差,早期诊断困难。
特点是局部侵袭性强,容易复发和转移,长期生存率低。
我院收治一例子宫内膜间质肉瘤术后2年复查胸部CT提示双肺多发结节,经病理证实为胎盘部位滋养细胞肿瘤。
一、病例资料:患者女 43岁已婚孕4产2.因“子宫内膜间质肉瘤术后2年,发现双肺结节2月”于2014年3月23日入院。
15岁月经初潮,平素月经规律5/30天,量中,无痛经。
既往顺产一次,人流两次;于2000年行双侧输卵管结扎术,2003年行双侧输卵管吻合术,2004年顺产一次。
2012年11月23日因“经期延长”在当地医院行筋膜内全子宫切除术+左侧输卵管切除术,术后病检提示子宫癌肉瘤。
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a rXiv:083.21v1[mat h.ST]14M ar28The Annals of Statistics 2008,Vol.36,No.1,403–427DOI:10.1214/009053607000000703c Institute of Mathematical Statistics ,2008ENDOGENOUS POST-STRATIFICATION IN SURVEYS:CLASSIFYING WITH A SAMPLE-FITTED MODEL By F.Jay Breidt 1and Jean D.Opsomer 2Colorado State University Post-stratification is frequently used to improve the precision of survey estimators when categorical auxiliary information is available from sources outside the survey.In natural resource surveys,such in-formation is often obtained from remote sensing data,classified into categories and displayed as pixel-based maps.These maps may be constructed based on classification models fitted to the sample data.Post-stratification of the sample data based on categories derived from the sample data (“endogenous post-stratification”)violates the standard post-stratification assumptions that observations are clas-sified without error into post-strata,and post-stratum population counts are known.Properties of the endogenous post-stratification estimator are derived for the case of a sample-fitted generalized lin-ear model,from which the post-strata are constructed by dividing the range of the model predictions into predetermined intervals.Design consistency of the endogenous post-stratification estimator is estab-lished under mild conditions.Under a superpopulation model,consis-tency and asymptotic normality of the endogenous post-stratification estimator are established,showing that it has the same asymptotic variance as the traditional post-stratified estimator with fixed strata.Simulation experiments demonstrate that the practical effect of first fitting a model to the survey data before post-stratifying is small,even for relatively small sample sizes.1.Introduction.Post-stratification (PS)provides a convenient and in-expensive way to improve the precision of estimators in a survey,and is very2 F.J.BREIDT AND J.D.OPSOMERwidely used.In traditional PS,survey observations are classified without er-ror into two or more categories,called post-strata,where the corresponding population counts in those categories are known from some source outside the survey.In surveys of human populations,post-strata are often demo-graphic subgroups,with population counts available from a census.In nat-ural resource surveys,post-strata may be landcover or-use classifications, with population counts obtained from remotely sensed data.An important example of a natural resource survey is the Forest Inven-tory and Analysis(FIA)program conducted by the U.S.Forest Service(see, e.g.,Frayer and Furnival[5]for a description).In FIA,data of interest are collected annually during intensivefield visits and are used to produce offi-cial estimates for a large number of forest attributes.In the Interior West region of the United States,FIA estimates are computed as PS estimators, with the strata defined by homogeneous landuse and groundcover categories (e.g.,nonforest,broadleaf forest,etc.).Population totals and sample point classifications for those categories are obtained from maps,which are main-tained in a geographic information system(GIS).These maps are derived from satellite imagery and other ancillary data layers.Satellite imagery from the Landsat Enhanced Thematic Mapper Plus (ETM+)as well as from the Moderate Resolution Imaging Spectroradiome-ter(MODIS)is an important source of remotely sensed data for mapping vegetation over large geographic extents.These data consist of collections of pixel-based maps of physical measurements,such as reflectance values at different wavelengths,which cannot immediately be converted into useable classifications.Instead,categories are obtained byfirst“training”a classifi-cation algorithm on existing satellite imagery and other ancillary digital in-formation,and then predicting the categories of all pixels in the region using that algorithm.Because of the multidimensional and often highly nonlinear nature of the relationships among the variables,the classification algorithms in use today can be quite complex.Examples of such algorithms for forest resources are neural nets and expert systems(Moisen and Frescino[7]).The end result of the classification is a digital(raster)map showing the geo-graphical distribution of the classes over a region of interest.This map is often an important“deliverable”for the organization producing it,and is used by scientists and land managers for a variety of purposes.Because of the large sample size,detailed nature and high quality of the FIA data,it is attractive to use FIA data to train classification algorithms to produce landcover maps.There are numerous local as well as nationwide mapping efforts that use FIA data for this purpose. Some examples of national efforts include development of the National Landcover Data(/mrlc/nlcd.html),Landfire (/),and FIA’s forest type mapping(Ruefenacht,ENDOGENOUS POST-STRATIFICATION3 Moisen and Blackard[10]).Questions have been raised about the appropri-ate use of these maps in FIA’s PS estimation process(Scott et al.[12]), because the post-strata are delimited with error(since they are based on a modelfit)and depend on the sample observations themselves.This vio-lates two fundamental assumptions of traditional PS:the exact post-stratum counts for the population are unknown,and the classification of the sam-ple observations into the post-strata is imperfect.Therefore,it is not clear whether the resulting estimator continues to be consistent and whether the traditional variance estimator remains valid.We explore the statistical properties of survey estimators that are post-stratified based on a modelfitted to the sample observations.To emphasize the relationship between the survey data and the stratification,we will refer to such an estimator as an endogenous post-stratification estimator,or EPSE for short.The EPSE is useful in practice whenever population information to construct traditional post-strata is not available,but predictions from a sample-fitted classification model can be generated for the entire population. We restrict our attention to classification schemes based on parametrically specified generalized linear models(McCullagh and Nelder[6]).Some of our results will be further restricted to the case of equal-probability sampling, as is used in much of FIA.An alternative to the EPSE approach is to construct a regression estima-tor,using the available auxiliary variables as regressors.This can be done using linear models as in the generalized regression estimation(GREG) approach(Cassel,S¨a rndal and Wretman[3]),nonlinear models(Wu and Sitter[14])or nonparametric models(Breidt and Opsomer[2]and Breidt, Claeskens and Opsomer[1]).Since these models use the auxiliary variables directly,instead of relying only on a classification based on these variables, a properly constructed regression estimator might be more efficient than the EPSE and would have known design properties.However,there are a number of reasons why the EPSE could still be preferable in practice. First,suitable classification algorithms have already been developed(in-volving extensive variable selection,model validation and calibration)and maps with well-defined categories are being produced.These maps synthe-size information from many layers of geospatial data,so it is operationally efficient to use the generated categories in other estimation problems,rather than building new regression models.Further,categories in the classification can often be readily interpreted(e.g.,forest/nonforest),whereas the remote sensing variables(e.g.,reflectance at a specific wavelength)are not,so that it is easier to explain the estimation procedure and the resultingfits to diverse end users.Second,both maps and survey estimates are typically generated by the same organization,so it is clearly desirable to ensure that the survey es-timates are calibrated to the map“control”totals.This is automatically achieved under the EPSE approach,but not with a regression estimator.4 F.J.BREIDT AND J.D.OPSOMERThird,PS weights based on a modest number of classes may tend to bemore stable than the weights obtained from regression estimation,especiallyin cases where many potentially correlated variables are used in the regres-sion model.In particular,PS weights are guaranteed to be nonnegative, while regression weights are not.Negative weights are an especially seri-ous consideration if survey data are to be used in modelfitting,with many statistical programs unable to properly operate in the presence of negativeweights.Finally,the EPSE estimator is robust in the sense that it can compete with the regression estimator when the regression model is correctly specified,and can dominate the regression estimator when the regression model is misspecified.The EPSE is defined in Section2and its properties are described in Sec-tion3,first under a general probability sampling design and then undera superpopulation model.Section4describes simulation experiments per-formed to assess the practical consequences of endogenous PS in a design-based context,and closes with a brief discussion.Proofs are provided in the Appendix.2.Notation and definitions.2.1.Post-stratification.Consider afinite population U N={1,...,i,...,N}.For each i∈U N,an auxiliary vector x i is observed.A probability sam-ple s of size n is drawn from U N according to a sampling design p N(·),where p N(s)is the probability of drawing the sample s.AssumeπiN= Pr{i∈s}= s:i∈s p N(s)>0for all i∈U N,and defineπijN=Pr{i,j∈s}= s:i,j∈s p N(s)for all i,j∈U N.For compactness of notation we will suppress the subscript N and writeπi,πij in what follows.Various study variables,generically denoted y i,are observed for i∈s.We now introduce some nonstandard notation for PS that will be usefuland a knownin our later discussion of endogenous ing the{x i}i∈UNis constructed and used to partition vectorλ,a scalar index{m(λ′x i)}i∈UNU N into H strata according to predetermined stratum boundaries−∞≤τ0<τ1<···<τH−1<τH≤∞.Choice of these boundaries is discussed in Section3.3below.For exponentsℓ=0,1,2and stratum indices h=1,...,H,we define1A Nhℓ(λ)=N i∈U N yℓi I{i∈s}ENDOGENOUS POST-STRATIFICATION 5where I {C }=1if the event C occurs,and zero otherwise.In this notation,stratum h has population stratum proportion A Nh 0(λ),design-weighted sample post-stratum proportion A ∗Nh 0(λ),and design-weighted sample post-stratum y -mean A ∗Nh 1(λ)/A ∗Nh 0(λ).The traditional design-weighted PS es-timator (PSE)for the population mean ¯y N =N −1 i ∈U N y i is thenˆµ∗y (λ)=H h =1A Nh 0(λ)A ∗Nh 1(λ)A ∗Nh 0(λ) y i =i ∈s w ∗is (λ)y i ,where the sample-dependent weights {w ∗is (λ)}i ∈s do not depend on {y i },and so can be used for any study variable.For the important special case of equal-probability designs,in which πi =nN −1,we write A nhℓ(λ)=1A nh 0(λ)=i ∈s w is (λ)y i ,(5)where the weights {w is (λ)}i ∈s are obtained by substituting nN −1for πi in(3).2.2.Classification based on a generalized linear model.The notation introduced above does not indicate how the function m (·)might be con-structed,nor how values for the parameter vector λshould be determined.One possibility is to suppose that a particular study variable,z i ,follows a generalized linear modelE(z i |x i )=m (λ′x i ),Var(z i |x i )=v (x i ),(6)where the expectations are with respect to the model.[For concreteness,think of z i as a forest/nonforest indicator,with logistic mean function m (λ′x i )=exp(λ′x i )/{1+exp(λ′x i )},and x i derived from satellite imagery.]We will refer to z i as the PS variable.If λwere known,we could use m (λ′x i )as an index to form the PSE in(3)for any study variable y i (even though the PS is based on a single PS variable z i ,the resulting weights can be applied to any response variable y i ).If model (6)is true,then m (λ′x i )is a good predictor for z i .Hence,the estimator (3)applied to the study variable z i will be more efficient6 F.J.BREIDT AND J.D.OPSOMERthan the Horvitz–Thompson estimator,¯zπ=N−1 i∈sπ−1i z i,which ignores the auxiliary variables x i.For other study variables y i,the efficiency of(3) relative to¯yπ=N−1 i∈sπ−1i y i will depend on the relationship between the PS variable z i and the y i.2.3.Endogenous post-stratification.In endogenous PS,the vectorλis unknown,so that estimator(3)is infeasible.Instead,λis estimated from the sample{(x′i,z i):i∈s}byˆλusing,for instance,maximum likelihood estimation and for any i∈U N,z i is predicted byˆz i=m(ˆλ′x i).The endogenous post-stratification estimator(EPSE)for the population mean¯y N is then defined asˆµ∗y(ˆλ)=Hh=1A Nh0(ˆλ)A∗Nh1(ˆλ)A nh0(ˆλ)= i∈s w is(ˆλ)y i.(8)Intuitively,it is reasonable to expect that ifˆλis a“good”estimator for λ,then the estimator(7)will behave like the estimator(3),at least asymp-totically.We show this equivalence in the sense of design consistency under mild design assumptions in the next section.Such results do not readily yield rates of convergence,becauseˆµ∗y(λ)is not a differentiably smooth function ofλ,so that traditional Taylor series approaches for the analysis of nonlinear survey estimators(e.g.,S¨a rndal et al.[11],Chapter5)cannot be applied.We therefore restrict our attention to the equal-probability case and study the model-based properties ofˆµy(ˆλ),by exploiting the fact that the model ex-pectations of the quantities in(1)and(4)are smooth functions,even though the quantities themselves are not.In particular,we establish a central limit theorem and a consistent variance estimator forˆµy(ˆλ)under an assumed superpopulation model.Section4provides simulation evidence that these good model properties also carry over into good design properties.3.Main results.3.1.Design assumptions and design consistency.We assume the general probability sampling design described in Section2.1and consider an asymp-totic framework in which N→∞while the number of strata,H,and their boundaries,{τh},remainfixed.Assume:ENDOGENOUS POST-STRATIFICATION7•D1.The covariates{x i}satisfy x i ≤M<∞.Forλ=0,the empirical distribution function G Nλ(z)=N−1 i∈U N I{x′iλ≤z}converges uniformly in z to a limit Gλ(z),lim N→∞sup z|G Nλ(z)−Gλ(z)|=0,where the limit is almost sure if the covariates are stochastic.•D2.The link m(·)is a known,strictly monotone function,λ=0is an unknown parameter vector,and m−1(τh)(h=1,2,...,H)are continu-ity points of Gλ(z).Further,Gλ(m−1(τh))−Gλ(m−1(τh−1))>0for h= 1,2,...,H.•D3.There is a sequence of estimators ofλ,{ˆλ},with the property that for everyε>0,there existsδε∈(0,∞)such that Pr{ ˆλ−λ >δε}<εfor all N,where the probability is with respect to the sampling design and the covariate model.πi≥π∗N>0where Nπ∗N→∞,and there exists •D4.For all N,min i∈UNκ≥0such that N1/2+κ(π∗N)2→∞andmaxi∈U N j∈U N:j=i∆2ij=O(N−2κ)as N→∞,where∆ij=πij−πiπj.satisfy lim sup N→∞N−1 i∈U N y2i<∞.•D5.The study variables{y i}i∈UNRemarks.1.Note that no stochastic model is assumed for the{y i}in this design-basedsetting.Randomness comes from the probability mechanism that selects s,and possibly from the process generating x i.2.The uniform convergence in D1is met by independent and identicallydistributed sequences(Glivenko–Cantelli lemma),stationary ergodic se-quences(Tucker(year?)),certain deterministic sequences[e.g.,polyno-mials of the form x′iλ= p j=0λj(iN−1)j],and so forth.3.D2ensures that the post-strata are nonempty and can be unambiguouslydetermined from the inverse link;D3asserts that the parameters in the generalized linear model can be estimated consistently.4.Thefirst part of D4allows for sparse sampling in the sense thatmin i∈Uπi→0is allowed as N→∞.The second part of D4allows Nfor nontrivial dependencies in the sampling.Sparser sampling is possible under weaker design dependence.For example,under simple random sam-pling without replacement max i∈UN j∈U N:j=i∆2ij=(N−1)−1(n/N)2(1−n/N)2=O(N−1)so that D4holds withκ=1/2.On the other hand, consider single-stage cluster sampling of m equally sized clusters from M clusters via simple random sampling without replacement.All elements in each selected cluster are observed.Let c denote the cluster size,and8 F.J.BREIDT AND J.D.OPSOMERassume it isfixed as cm=n→∞and cM=N→∞.Thenmaxi∈U N j∈U N:j=i∆2ij=(c−1) m M 2+(M−1)c −m M 2≤ (c−1)+cENDOGENOUS POST-STRATIFICATION 9is continuous in λfor ℓ=0,1,2,and αh 0(λ)>0for h =1,...,H .In par-ticular,the variables z i |x i are conditionally independent random variables withE(z i |x i )=m (λ′x i ),Var(z i |x i )=v (x i ),E(z 4i |x i )≤K 1<∞.•M5.The sample s is selected according to an equal-probability design of fixed size n ,with πi =nN −1→π∈[0,1]as n,N →∞.While the conditional independence in M4rules out certain clustered de-signs,it seems quite plausible in large-scale natural resource surveys,where it is often the case that sampling locations are widely dispersed and,after correcting for covariates,no spatial dependence remains.(We investigate the effect of residual spatial dependence via simulation in Section 4.)The equal-probability design assumed in M5is also somewhat limiting,but it does cover the systematic designs used by the U.S.Forest Service in FIA.Further,our results extend trivially to the case of a fixed number of design strata (determined prior to sampling,unlike post-strata)with a large equal-probability sample within each stratum,and possibly unequal probabilities across strata.3.3.Central limit theorem.The proof of consistency and asymptotic nor-mality for the EPSE in (8)with respect to the superpopulation model is deferred to the Appendix .Result 2.Under assumptions M1–M5,1N −1/2(ˆµy (ˆλ)−¯y N )L →N (0,V y λ),whereV y λ=H h =1Pr {τh −1<m (λ′x i )≤τh }Var(y i |τh −1<m (λ′x i )≤τh ).Remarks.1.When H =1,the asymptotic model variance of ˆµy (ˆλ)−¯y N from Result2is 1NVar(y i ).(10)This is the model variance of ¯y π−¯y N under any equal-probability design,or the model-averaged design variance of the ordinary sample mean under simple random sampling without replacement.10 F.J.BREIDT AND J.D.OPSOMER2.For general H,the asymptotic model variance in Result2is equal to thatof the traditional post-stratified estimator(i.e.,in whichλis known).This variance has an intuitive form:it sums stratum fraction times within-stratum variance of y over the post-strata.Note thatHh=1αh0(λ) αh1(λ)αh0(λ) 2=(E[y i])2,with equality only if the post-stratum means are all identical:αh1(λ)/αh0(λ)≡E(y i)for h=1,...,H.Thus,we have thatVar(y i)=Hh=1αh0(λ)αh2(λ)αh0(λ)− αh1(λ)n 1−nn 1−nENDOGENOUS POST-STRATIFICATION11 measures the asymptotic loss in efficiency of the EPSE relative to the re-gression estimatorˆηz(ˆλ).The EPSE will be as asymptotically efficient as the regression estimator(12),that is,V zλ=E[v(x i)],if the m(λ′x i)are constant within each stratum.If this is not the case,the EPSE will fail to match the asymptotic efficiency of the regression estimator.It should be noted that although the EPSE for the study variable z is therefore likely to be dominated by the regression estimator(12),this is not necessarily the case if a different regression estimator is used.For other study vari-ables y,the EPSE may be better than a regression estimator,depending on the relationship between y and x in the population.We explore this further in the simulation study in the next section.4.In some applications,it might be of interest to select the{τh}defining thecategories to improve the efficiency of the EPSE for a“target”variable z.As noted in Section1,these class boundaries are often determined by the requirements of the classification algorithm and the desired map output to which the EPSE is calibrated,so that little choice might be available when they are applied in the construction of the post-strata,except for possibly collapsing neighboring post-strata in case of small sample sizes.If the operational environment allows for the selection of stratum boundaries, then boundaries might be constructed by applying the cumulative root-density method described in Cochran[4],Section5A.7,to the m(ˆλ′x i), though this method requires further study.3.4.Variance estimation.We now consider variance estimation for the EPSE.The standard post-stratified design variance estimator under simple random sampling without replacement isˆV(ˆµy(λ))=1N H h=1(N h N−1)2n 1−n A nh0(λ)A nh2(λ)−A2nh1(λ)/A nh0(λ) n 1−n A nh0(ˆλ)A nh2(ˆλ)−A2nh1(ˆλ)/A nh0(ˆλ)12 F.J.BREIDT AND J.D.OPSOMER Under assumptions M1–M5,as n,N→∞ˆV(ˆµy(ˆλ))−1/2(ˆµy(ˆλ)−¯yN)L→N(0,1).4.Simulations.The two main goals of the simulation are to assess the design efficiency of the EPSE and the design bias of the variance estimator (14);we also look at confidence interval coverage.The simulations are per-formed in a setting that mimics a real survey,in which characteristics of mul-tiple study variables are estimated using one set of weights.The weights for estimation of a mean are the Horvitz–Thompson estimator(HTE)weights {n−1}i∈s,the PSE weights{w is(λ)}i∈s,the EPSE weights{w is(ˆλ)}i∈s,or the simple linear regression(REG)weights(e.g.,(6.5.12)of S¨a rndal et al.[11]).The HTE does not use auxiliary information;the PSE uses auxiliary information with a known model;and the EPSE and REG use auxiliary information withfitted models.We consider two different models for the PS variable,z i.First,we look at the situation in which the true model in(6)for the PS variable is continuous and follows a ratio model(see,e.g.,S¨a rndal et al.[11],page226),so that m(·)is the identity function.Second,we consider the case where the PS variable is binary and m(·)is the logistic link.4.1.Ratio model post-stratification.Wefirst describe the simulation setup for the ratio model PS.We assume a population of size N=1000with eight survey variables of interest.For the PS variable z i,we let E(z i|x)=m(λ′x)= 1+2(x−0.5)and Var(z i|x)=v(x)=2σ2x,while for the remaining seven variables(y i),we take their mean functions to be equal to g k,quadratic:g1(x)=1+2(x−0.5)2,bump:g2(x)=1+2(x−0.5)+exp(−200(x−0.5)2),jump:g3(x)={1+2(x−0.5)}I{x≤0.65}+0.65I{x>0.65}, exponential:g4(x)=exp(−8x),cycle1:g5(x)=2+sin(2πx),cycle2:g6(x)=2+sin(8πx),white noise:g7(x)=8,and variance equal toσ2,with x uniformly distributed on(0,1)and the errors for all functions independent and normally distributed.The variance function for the PS variable is chosen so that,averaging over the covariate x, we have E[v(x)]=σ2.Thus,the PS variable and the remaining seven study variables all have the same variance,averaged over x.We considered two different values ofσ:0.25and0.50.For each noise level,wefixed the population(i.e.,simulated N values for each of the eight variables of interest)and drew1000replicate samples ofENDOGENOUS POST-STRATIFICATION13 size n=50and n=100,each via simple random sampling without replace-ment from thisfixed population.We constructed HTE and REG weights using standard methods.We used the model for the PS variable for con-structing the PSE weights,using known parameter values,and the EPSE weights,usingfitted parameter values.The weights were then applied to the remaining seven study variables.Hence,the PS model will only be cor-rectly specified for the PS variable.The EPSE and PSE were calculated using two strata with boundariesτ=(−∞,1.0,∞),using four strata with boundariesτ=(−∞,0.5,1.0,1.5,∞),and using six strata with boundaries τ=(−∞,0.5,0.75,1.0,1.25,1.5,∞).Table1summarizes the design efficiency results as ratios of the MSE of the HTE,PSE(H),or REG over the MSE of the EPSE(H),where H=2,4 or6strata.Overall,the results show that the EPSE behaves as expected:it produces a large improvement in efficiency relative to the HTE for the vari-able on which the PS is based,as well as for most of the other variables that are correlated with it.When the number of strata increases,the efficiency gains become more pronounced,though EPSE begins to break down due to post-stratum sample sizes of zero or1when the number of strata is large and the sample size is small.When the relationship between the variables of interest and the auxiliary variable becomes less strong(i.e.,higher noise levels),the efficiency gains of EPSE decrease.EPSE is typically as good as or better than REG for study variables on which the regression model is badly misspecified,but loses out to REG when the true model is linear or nearly so(“bump”).The“white noise”variable shows that,when a variable is not related to the stratification variable,the efficiency is near that of the HTE,but with decreasing efficiency as the number of strata increases(since the strata are entirely unnecessary).Table1also shows that the EPSE is essentially equivalent to the PSE in terms of design efficiency,even for n=50,implying that the effect of basing the PS on afitted model instead of on exogenous strata is negligible for moderate to large sample sizes.Next,we consider the variance estimator proposed in(14)by computing percentage relative biases(100%times the variance bias divided by the true design variance)for the PSE variance estimator(13)and the EPSE variance estimator(14).These results(not tabled)show that neither estimator is unbiased,and both tend to show negative bias(147of the192cases in Table 1).The bias of the EPSE variance estimator tracks that of the PSE variance estimator closely for low noise,low number of strata and large sample size, but the tracking deteriorates as noise increases,number of strata increases or sample size decreases.Finally,we assess the quality of the normal approximation by constructing approximate95%confidence intervals from the pivotal quantity in Result3. These confidence intervals,ˆµy(ˆλ)±1.96{ˆV(ˆµy(ˆλ))}1/2,attained empirical16 F.J.BREIDT AND J.D.OPSOMERcoverages(not tabled)ranging from92.1%to95.8%for the96combinations of noise level,sample size,number of strata and study variable.These em-pirical coverages track closely the empirical coverages of confidence intervals constructed from the PSE.We repeated the experiments withσ=0.25,n=50,and H=2,4or6 strata for the case with x i=i/(N+1)(i=1,2,...,N)and with the residuals for every variable autocorrelated:corr(z i,z j)=corr(y i,y j)=0.99|i−j|.This setting clearly violates the conditional independence assumption of M4.The results(not tabled)indicate that the EPSE remains essentially unbiased and its confidence intervals continue to have close to nominal coverage(92.9%–95.6%).Efficiency compared to HTE is even greater than in the condition-ally independent case,because positive autocorrelation is trend-like behavior that is captured to some extent by the post-strata.The variance estimator tends to have less negative bias or more positive bias than in the conditional independence case.Overall,these limited simulations suggest that EPSE maintains its good behavior outside of the limited setting described in the technical assumptions of Section3.4.2.Logistic model post-stratification.Since the theory of this paper cov-ers generalized linear models,the above simulation experiments were re-peated after replacing the ratio model for the PS variable by a logistic model, but keeping all other models the same.In this case,the PS variable z i is now a Bernoulli variable with expectation m(x)=exp(λ0+λ1x)/(1+exp(λ0+λ1x)).The values for(λ0,λ1)were chosen as(−10,20)for the“low noise”case(σ=0.25for the remaining variables)and as(−3,6)for the“high noise”case(σ=0.50for the other variables).These levels will be denoted as the “steep”and the“flat”model.Two,four and six equal-size strata partition-ing[0,1]are considered for the PSE and EPSE.All estimators remain as in Section4.1.Table2displays the relative efficiency for the logistic model simulations using n=200(the logisticfits were problematic at smaller sample sizes).The findings are very similar to those discussed for the ratio model.The EPSE continues to improve substantially over the HTE for most variables,while not deviating substantially from the PSE with known stratum classifications. Further,the EPSE continues to be competitive with the REG estimator. Efficiency tends to increase from two to four strata,but level offfrom four to six strata.Approximate95%confidence intervals computed from the pivotal quan-tity in Result3attained empirical coverages(not tabled)ranging from93.7% to96.3%for the48combinations of model,number of strata and study variable in Table2.These empirical coverages track closely the empirical coverages of confidence intervals constructed from the PSE,and are quite close to nominal in spite offinite-sample bias in the variance estimator.。