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杜甫的名詩范文1
當中的主題在《天使的憤怒》中,詹妮弗·帕克是其中的焦點人物,縱觀詹妮弗·帕克的一生,反抗是她的一個永恒宿命,從登上舞臺開始,她就面對著一個支離破碎、慘淡不已的家庭環境。母親因為外遇而離去,這給她帶來了深刻的影響,母親的行為不僅僅在傷害著她年幼的心靈,也在改變著她的人生軌跡。她的人生起點似乎就是在反抗母親給她帶來的無窮傷害和巨大的陰影,而母親的傷害實際上不僅僅是家庭的缺失,更帶來了一種道德上的壓迫感。主人公并不愿意接受自己的母親就是一個不顧正義和道德,只是簡單地追求私欲的人,她厭恨這種行為,也就產生了一種更加嫉惡如仇的情緒,或許她對正義的向往和追求是在努力撫平她童年時代受到的傷害。這種對自己命運的反抗在主人公登場時,就已經展現出一種悲劇的意味。在之后的人生軌跡當中,詹妮弗·帕克更是在跟自己的命運做著無窮的斗爭,她心愛的男子是一個有婦之夫,在這一場違背社會倫理道德的戀愛當中,主人公無疑處于一種弱勢的低位。因為主人公的愛情實際上是違背了社會當中的倫理道德,違背著自己內心當中堅守的信念,主人公早年正是面臨著一種十分艱巨的考驗,自己至親的母親就曾經違背過婚姻和道德的底線。此刻主人公反抗的或許是自己內心當中為自己設下的道德壁壘,這種內心當中的矛盾對于主人公而言不啻于一種巨大的精神折磨。
與此同時,對自己命運的妥協也是主人公命運當中的另一大主題。她在反抗之后,依舊無法擺脫和超越自己的生命歷程給自己設下的重重障礙。首先,對待愛情,主人公正是采取了一種妥協的態度。主人公的男友實際上是一個擁有家庭并愛尋花問柳的男人,但是主人公依舊希冀能夠以自己的真情感動自己的男友,使其能夠擺脫家庭和自己相結合。這實際上又是一種妥協,對自己并不能引以為豪的出身和家庭進行著妥協,她的母親正是選擇了背離自己的家庭,違反社會當中的道德和良知,選擇自己心目當中的幸福,從而造成了詹妮弗·帕克乃至其父親的人生悲劇。詹妮弗·帕克在幾經起伏之后也選擇了同自己母親一樣的道路,而這條道路事實上正是當年的她的人生悲劇的起源,更為深刻的人生悲劇發端于對自己的孩子的愛戀。這個孩子產生于一場違背世間倫常的愛戀,但與此同時也就更加重了主人公的悲劇命運。主人公為了自己的幼子能夠免于黑幫的毒手,最終徹底背棄了自己當初的理想,為黑幫服務。黑幫正是主人公詹妮弗·帕克當年所希望打擊的社會敗類的集中體現,但是由于自己愛子心切,最終只能選擇成為黑幫的一個幫兇。這種對理想的背叛或許已經足以讓她的人生不再擁有以往的意義,喪失自己的目標甚至存在的價值。
反抗和妥協并不是相互割裂的,而是始終交織在一起的。主人公每次對命運的反抗過程當中面臨的困難和自己的內心欲望實際上都是一種妥協的誘因,而每次的妥協給主人公帶來的痛苦又必然增強她進行反抗的愿望。當這兩種情感交織在一起時,主人公的內心是無比矛盾的,在歷經人生的劫難之后,所感受的情感也是無比凄涼的。二、家庭悲劇——詹妮弗·帕克悲劇
命運的起源家庭往往被譽為人類心靈的港灣,就每個人而言,家庭也往往是人類接受教育并最終走向社會的起點。家庭對人的影響無疑是十分巨大的,它甚至在某種意義上可以決定一個人一生的軌跡。而事實上,正是詹妮弗·帕克的家庭悲劇決定了她在今后的生命當中必然面對著十分巨大的精神壓力。當她在選擇自己的人生道路時,她也在為自己的母親贖清罪過,希望能夠通過自己的努力最終維護正義,反抗那些自己曾經深深為之不齒的東西。母親的所作所為事實上給主人公施加了一種恒久的影響,這種影響其實就是主人公生命的重擔。
此外,家庭的悲劇事實上也給主人公帶來一種極大的恐懼。主人公并不希望自己重蹈父親的覆轍,孤獨地面臨生活的考驗和重擔。但是父輩的這種經歷又在某種意義上給自己留下一種精神上的宿命感。當一個人十分熟悉一種生活環境時,她潛意識當中對這種生活方式又具有某種認同感。因為這種生活正是她最為熟悉的一種生活狀態,甚至當她希望通過自己的努力擺脫這種生存狀態時,都在一遍遍地重復著這種狀態給自己帶來的種種記憶。
可以做出這樣的猜想,主人公詹妮弗·帕克一直都試圖用事業的成功和自己身份、地位以及巨大的成就感來掩蓋自己內心當中的傷感,并縫合母親的離去和早年的痛苦人生給自己帶來的巨大傷痛。當一個人的初衷就已經是十分扭曲時,其結果也必然是嚴重違背初衷的。因為事實上她追尋的是一個錯誤的目標,并且使用了并不正確的手段,她希望自己能夠洗刷掉母親給自己帶來的內心陰影,但殊不知這種陰影并沒有辦法洗刷,人們能做的僅僅是轉換自己看待這些傷痛的視角,而解決這種內心恐懼的辦法也只不過是正視之并寬恕之。正視這種傷痛的存在,仔細地剖析傷痛產生的原因,最終寬恕傷痛的施加者,不讓她的決定破壞掉自己的人生,這應當成為她的正確選擇。但是由于她的懦弱和自卑,她并不敢坦然地面對自己的過往,而是選擇用一種其他的手段加以掩飾。
杜甫的名詩范文2
太陽能是一種可再生的清潔型能源,LED是一種節能、環保的固態電光源。二者的結合太陽能半導體照明是最佳的環保節能組合,獨立光伏LED照明系統就是二者的完美結合。本文從系統組成、充電控制、放電設計、調試等四個方面研究了獨立光伏LED照明系統的設計與實現。
【關鍵詞】獨立光伏 LED 照明系統 設計
能源問題和環境問題是關系到人類社會可持續發展的重要問題,太陽能是取之不盡用之不竭的綠色能源,太陽能的應用備受關注。獨立光伏LED照明系統結合了太陽能發電和LED光源的優勢,實現了最大能效的發揮?;谝陨?,本文對獨立光伏LED照明系統的設計與實現進行了簡要研究。
1 系統組成分析
獨立光伏LED照明系統工作的過程中,通過光伏電池陣列來吸收光能,并將吸收到的光能轉換為太陽能,從而為LED照明提供電力能源。傳統的光伏LED照明系統中,LED恒流驅動電路和DC-DC變換電路是相互獨立的,系統有著復雜性、效率低、可靠性低的缺陷,兩個相互獨立電路在結構上和原理上有著一定的相似性,而光伏LED照明系統不會同時進行充電過程和放電過程,因此可以引入雙向變換器,以此來實現電路的簡化,優化光伏LED照明系統性能,如果引入的雙向變換器只具備單一的降壓功能或升壓功能,則勢必會對系統的靈活性造成影響,同時限制了系統的適用范圍,因此可以引入Zeta/Sepic雙向變換電路。系統的結構圖如圖1所示。
在充電電路和放電電路中都采用Zeta/Sepic雙向變換,通過控制器實現在LED負載和光伏電池之間的切換。在充電的過程中,轉換開關切換到光伏電池,通過Zeta變換器實現蓄電池的充電,在放電的過程中,轉換開關切換到LED照明負載,通過Sepic變換器來給LED照明負載供電。
2 放電設計
在放電的過程中,切換控制開關與LED照明負載連接,蓄電池主要為LED照明負載提供電源,其等效電路圖如圖2所示,蓄電池通過Sepic變換器向 LED照明負載的供電。
在電流連流的工作模式下,主開關管Q2導通,則蓄電池箱L2儲能,此時C1和L1兩條回路處于導通狀態,LED照明負載的電能由C2提供;主開關管Q2斷開的時候,蓄電池經過L2、C1、D2之后,實現向LED照明負載的供電,此時L2、L1以及C1三條回路處于導通狀態。
LED特性曲線有著非線性的特征,且其對溫度十分敏感,因此在供電的過程中需要采用恒流電源,以Sepic變換器為基礎,采用電流閉環控制方式,以此來實現LED照明負載的恒流驅動。將LED驅動芯片為控制芯片,最好采用使用滯回流模式控制的芯片,這樣就不需要復雜的輔助回路條件來瞬間響應,從而適合于蓄電池的LED驅動控制。驅動芯片內部有著較為復雜的控制邏輯,但其管腳相對較少,只需要在合適的選取元件就能夠實現對目標的有效控制,對于使用者來說十分方便。
3 調試
充電電路著重研究8:30-17:30時的實驗數據,對典型測試時刻系統采用的充電方式進行記錄,蓄電池初始荷電狀態為70%時,根據充電方式記錄數據表明,充電控制器能夠依照控制流程根據蓄電池所處工作狀態在MPPT充電、恒壓充電以及浮充三種方式之間進行切換,有效利用了太陽能,對于延長蓄電池使用壽命有著積極的意義。其調試時刻充電方式記錄表如表1。
光伏LED恒流驅動電路設計中,當蓄電池端電壓和環境溫度出現變化的時候,應當保持流過LED支路電流保持恒定,經過實驗測試來看,蓄電池電壓出現升高或降低等變化的時候,通過示波器能夠對流過LED之路電流的變化情況進行觀察發現,其電流幾乎為一條直線,基本沒有紋波出現。進一步進行測試,當環境溫度出現變化的時候,輸出電流也沒有出現明顯的變化,這說明驅動電路設計有著較好的恒流效果,同時其抗干擾能力較強。
4 結論
綜上所述,本文簡要分析了獨立光伏LED照明系統的結構,并從充電實現和放電設計兩個方面研究了系統的設計與實現,旨在為相關研究提供參考。
參考文獻
[1]聶曉華,趙忠凱.獨立光伏LED照明系統主電路設計與實現[J].南昌大學學報(工科版),2012,04:378-381.
[2]黃克亞,尤鳳翔.太陽能LED照明系統充電控制器設計[J].電氣傳動,2012,11:38-41.
[3]艾葉,劉廷章,王世松.獨立式LED太陽能光伏照明系統的設計[J].電力電子技術,2010,02:18-19+69.
[4]汪義旺,張波,林燕.太陽能LED照明用一體化電源設計[J].電源技術,2014,11:2099-2102.
杜甫的名詩范文3
近期,“警民直通車―上?!蔽⒉┓Q:上海警方以涉嫌故意殺人罪向檢察機關提請逮捕復旦大學“4?1”案犯罪嫌疑人林某。經警方初步查明,林某因生活瑣事與黃某關系不和、心存不滿,經事先預謀,3月31日中午,將其做實驗后剩余并存放在實驗室內的劇毒化合物帶至寢室,注入飲水機水槽。4月1日晨,黃某飲用飲水機中的水后出現中毒癥狀,后經醫院救治無效于4月16日下午去世。
僅僅因為生活瑣事就心存不滿,最后竟然狠心到用劇毒化合物毒死同學,這樣的冷面鐵心令人唏噓。在痛惜一條鮮活生命逝去的同時,人們不禁要問:究竟是什么樣的生活瑣事,點燃了林某心底的仇恨之火,乃至于狠毒到要毀滅他人的生命?前天,復旦校園開始為家境比較困難的黃某捐款,大家希望類似的悲劇不要再發生。唯愿天堂里沒有仇恨,人與人之間能相互關愛、相互尊重生命。
“本是同根生,相煎何太急”,黃某所在的復旦大學醫學院一位教授的哀嘆,道出了很多人心中的不解。同在一個學校的醫學院求學已是緣分,何況還同在一個宿舍一起生活,本當情同手足,卻因瑣事不和、心存不滿而投毒害人,是嫌犯林某心理過于扭曲?還是我們的生命教育出現了問題?
以個案而論,林某的瘋狂之舉多少折射出其心智的不夠健全。按理說一個復旦的碩士研究生,其智商、情商至少不會低于普通人,人格也不會有什么問題。可是縱觀林某的作案動機和過程,卻有點令人難以置信:一點瑣事,哪怕心存不滿,常人概不會積怨到要毀滅別人的生命,更不會想到要盜用實驗室的劇毒化合物來奪人性命。因而,表面上看,生活中的瑣事是悲劇發生的導火索,但在瑣事背后,掩蓋的恐怕是個體的性格扭曲和心智不健全。我們常常說“沖動是魔鬼”,但實際上每個人心靈深處都會有“魔鬼”,只是人格健全的人知道如何用理性控制而已。
但穿透瑣事背后,我們不難發現,即便是在高校中,生命教育仍然是個不得不重視的話題。遠的如清華大學、北京大學兩起鉈鹽中毒案,近的如南京航空航天大學學生口角刺死室友、南昌航空大學研究生宿舍發現腐尸……在這些事件中,尊重生命這個最基本的社會準則,卻被高智商的學子們拋棄。若再追溯,我們的教育從小學到大學,甚至到博士,都難有生命教育的一席之地。有人將其歸之于唯利是圖社會風氣的影響,教育被功利化,于是生命在這些利己價值觀面前顯得一文不值,漠視他人生命,甚至粗暴地剝奪他人生命,凸顯了生命教育在教育體系中的不可或缺。
復旦大學的投毒案,一方面暴露了高校實驗室對劇毒化合物管理上存在著巨大漏洞,這也表明清華、北大的鉈鹽中毒案并沒有引起足夠的重視;另一方面,高校學子的心理健康問題也應納入監測對象。在社會焦慮感普遍存在的大環境下,高智商群體的心理干預很有必要,像廣東省高校已連續5年將研究生納入心理健康的重點檢測對象,這對其他高校多少是個啟示。此外,高校能否提前介入學生的管理,比如說在入學體檢中加入人格檢測、心理檢測,再根據不同的結果作出適當的干預,以避免不必要的生活沖突,也值得考慮。
杜甫的名詩范文4
一、基本情況
1、個人狀況:在這次調查對象中,年齡在16-25歲的占47.3%,26-35歲的占30.4%,36歲以上的占22.3%。初中以下文化程度的占8.1%,初中文化程度的占50.7%,高中、職高、中專文化程度的占31.8%,大專以上文化程度的占7.4%。其中未婚的占47.3%,已婚的占52.7%。原創:來自蘇北農村的占85.1%,來自其他地區的占14.9%。通過當地勞動部門組織外出打工的占7.4%,通過婦聯組織外出打工的占7.4%,自己找工作的占71.6%,隨丈夫外出打工的占19.6%。
2、收入狀況:月工資收入在200-300元的占22.3%,在400-600元的占26.4%,600-800元的占26.4%,800-1000元的占14.2%,1000元以上的占10.7%。
3、打工目的:有61.5%的人打工的目的是為了掙錢,14.9%的人打工的目的是為了學技術,為了換環境,見世面、在城里安家的占23.6%。
4、思想觀念:通過調查顯示,有85%的人認為打工最大的收獲是開闊眼界,更新觀念;大多數人認為進城打工最大的苦惱是想回家又不能回家和找不到合適的工作。87.1%的人認為外出打工對家庭影響最大的是子女教育和家人團聚。67.1%的人認為自己正慢慢融入城市生活,是半個城里人。
5、婚姻觀念:有66.7%的人想嫁城里人,覺得生男生女都一樣的占81.2%。大多數人認為男人以社會為主,女人以家庭為主,男人應承擔一半的家務。
6、家庭生活:認為自己外出打工后在家庭中的地位提高很多、提高一點、沒有變化的各占1/3。絕大多數人沒有被丈夫打過。
7、業余生活:打工婦女業余時間常去的公共場所是市民廣場,主要的娛樂方式是看電視、逛街。最親近的朋友是老鄉、同事。
8、未來愿望:有84.5%的人打算長期生活在城市,未來三年打算在城里干下去的占95%。有90%的人想參加同致富有關的組織。
9、對城市的看法:多數人認為城市人的素質和農村人差不多,但瞧不起農村人,有點冷漠。認為城市的衛生狀況、生活條件比農村好。
二、存在問題
1、綜合素質有待提高。調查顯示,打工前參加過培訓的人占33.8%,未參加培訓的占66.2%。有50%的人知道勞動法、原創:合同法,而知道《婦女權益保障法》的人僅占22.2%。大多數人是通過媒體宣傳報道、相關書籍、街頭法制宣傳活動了解法律法規。由此反映出打工者的勞動技能較差,對自己的權益缺乏保護意識。
2、維權力度有待加大。在被調查者中,大多數人工作時間不少于10小時。如果加班,單位或雇主付加班費的僅占32.4%。有62.8%的人與所在單位沒有簽訂勞動合同,所在單位提供保險的僅占29.7%,81.2%的人所在單位不提供婦女病普查。只有33.3%的人在城里參加過選舉。當務工婦女的權益受到侵害時,只有35.8%的人尋求政府或婦聯的幫助,其余的選擇向同事、親友尋求幫助。
三、幾點建議
針對農村務工婦女工作、生活中存在的問題,建議:
1、加大培訓力度。通過舉辦各類技能培訓班,加強對務工婦女的技能培訓,提高務工婦女的技術水平。同時,通過講座、街頭宣傳咨詢活動擴大各種法律法規知識的宣傳面、覆蓋面,增強務工婦女的法律意識和自我保護能力。
杜甫的名詩范文5
【關鍵詞】 中醫學 中藥 臨床研究 隨機對照試驗 循證醫學
1 Introduction
It is generally accepted that all health interventions, including traditional Chinese medicine (TCM), should be as safe as possible prior to adopting them in clinical practice. There is a common misconception that herbal materials - including those used in TCM, known as Chinese materia medica (CMM) are harmless to humans because they come from natural sources [1]. In fact, TCM may cause serious adverse effects (AEs) when adulterated or used incorrectly. Although the potential toxicity of specific CMM interventions has attracted more attention worldwide as the use of herbal interventions increases [2, 3], most researches on TCM continue to focus almost exclusively on establishing efficacy and effectiveness. Our previous study reported that only 30% of randomized controlled trials (RCTs) of TCM reported AEs, and most of them were too vague on this topic for readers to appropriately determine the safety of the TCM interventions studied. Better reporting on AEs in RCTs of TCM is therefore required.
The Draft Consolidated Standards for Reporting Trials of Traditional Chinese Medicine (CONSORT for TCM) were published in Chinese and English in 2007 [4, 5] to solicit feedback from experts in different specialties. In that draft, one checklist item addressed the reporting of safety of TCM interventions. Upon further consideration, it became apparent that a single checklist item to address the issue of safety was not enough. The extension of the CONSORT statement on reporting of harm [6] has addressed how to illustrate the AEs in RCT of Western pharmaceuticals. Since it is essential to transparently illustrate the AEs of RCTs for all interventions, including those used in TCM, this article aims to enhance awareness of safety issues for TCM interventions by promoting improved reporting by 1) summarizing the types of AEs reported with TCM; 2) examining the impact of AEs on RCTs with TCM; and 3) formulating the reporting structure. The corresponding revisions of the draft CONSORT for TCM are also recommended.
2 Types of AEs
CMM products used in TCM can refer to materials of herbal, animal or mineral origin. Normally, AEs associated with CMM products used in TCM could be pided into five types as follows.
2.1 Unpredictable AEs Theoretically, TCM interventions are prescribed by clinical practitioners according to the golden principle of treatment based on syndrome differentiation. Even if this principle is followed, AEs cannot be entirely avoided, and toxicity (acute or chronic) or allergic reactions may occur. For example, Caulis Aristolochia manshuriensis (Guanmutong) is a commonly used Chinese herb in clinical practice, and has attracted attention for its significant nephrological toxicity in the last two decades [79]. The major compound in C.A. manshuriensis, aristolochic acid, induces acute tubular necrosis in the kidney, thus resulting in significant toxicity. But based on the Chinese medicine theories, it cannot be predicted. Allergy is another AE associated with the usage of TCM interventions [10] including allergic shock, allergic asthma and allergic purpura. Although a previous history of allergy to herbs can remind the practitioner to be careful, this knowledge is of little value for patients who have not previously been exposed to these allergens.
2.2 AEs arising from improper use TCM drug must be used according to TCM principles, and improper usage may result in AEs. Typically, improper usage involves 1) prescription without following the TCM therapeutic principles; 2) overdosage; 3) improper processing and preparation methods; 4) improper formulas.
Firstly, prescriptions should be based on the TCM treatment principles. If these principles are not obeyed, potentially efficacious interventions may produce AEs. For example, Rhizoma Coptidis (Huanglian) is very cold in nature and bitter in taste. Used properly, it can clear heat, dry dampness, drain fire and expel toxicity. Used improperly, it may damage the spleen and stomach resulting in nausea, vomiting, stomachache and loss of appetite in the short term; over the long term, improper usage may result in spleen qi deficiency. If the TCM theories are strictly followed, these AEs could be avoided.
Secondly, overdosage is another common reason for AEs with TCM intervention. For example, most AEs related to the root of Herba Asari (Xixin) are because of high dosages. Traditionally, the limitation of daily dosage of H. Asari is less than 3 grams, although debate exists on this topic [11]. Another typical case of overdosage is Herba Ephedra (Mahuang). Although there is no clinical evidence from any RCT to support the effect of H. Ephedra on weight loss, it continues to be used for this indication at doses much higher than the traditional dosage, which has resulted in AEs [12].
Thirdly, the processing and/or preparation method should be selected based on reducing the potential toxicity of herbs and formulas, since improper processing and/or preparation can increase the possibility of AEs. For example, Radix Aconiti (Wutou) should only be used in its processed form and should be boiled separately for at least 45 minutes before boiling together with other components in a formula to reduce the possibility of aconite poisoning, which may lead to toxicity in patients [13].
Furthermore, failure to follow basic TCM principles during the formulation of TCM formula may result in AEs as it is well known that some CMMs are incompatible with others and should not be combined in formulations. The most important guidelines are the "eighteen incompatible herbs" and the "nineteen antagonistic herbs". At the same time, an appropriate combination of CMMs can enhance therapeutic effects and reduce harmful side effects.
2.3 AEs arising from contamination Heavy metal and pesticide contamination in TCM interventions are major concerns and can result in AEs. The growing conditions as well as the processing procedures and preparation process may contribute to these contaminations [14]. They are known to have caused serious AEs, and will continue to be a serious concern. For example, mercury contamination can cause neurological disorders and nephrotoxicity [15]. It may also result in depression, irritability, forgetfulness, confusion, tremor, sensory disturbances, visual deficits, hearing loss, movement disorders and cognitive disturbances, etc [16]. Contamination with mercury in herbs can cause serious AEs [17]. In addition, contamination from nonTCM pharmaceutical products in TCM intervention is another potential source of serious AEs. For example, a clinical trial found that PCSPES, which is a proprietary formulation containing eight herbs that was marketed by Botanic Lab (Brea, CA) from 1966 to 2002, has side effects including reduced libido, hot flashes, diarrhoea, dyspepsia, leg cramps, nipple tenderness, and gynaecomastia, pulmonary emboli deep vein thrombosis, a transient severe bleeding diathesis [18]. These side effects were due to product contamination with diethylstilbestrol and warfarin and caused the withdrawal of this formula from the market in 2002 [19].
2.4 AEs arising from misidentification of CMMs There are many cases of confusion in species of CMM, and there are many reasons for the various types of confusion. A particular herb used in TCM may have different subspecies, each with a different use. For example, Radix Glycyrrhizae is used in Zemaphyte for atopic dermatitis [15]. Sometimes, the incorrect species could take the place of the intended species, thus leading to AEs. The first reported toxicity case involving aristolochic acid in Hong Kong was caused by mistaken use of Aristolochia mollissima Hance (Xungufeng) instead of the aristolochic acidfree CMM Solanum lyratum Thunb (Baiying), and this misuse resulted in renal failure and malignant urothelial changes [20].
2.5 AEs arising from drugherb interaction Potential herbdrug interactions continue to attract more and more attention due to possible AEs [2123]. Although it is believed that TCM could perhaps play an auxiliary role when combined with Western pharmaceuticals in the management of some diseases, including certain forms of cancer, there is generally insufficient evidence to support the efficacy and safety of such combination therapies. Herbal products may interfere with the metabolic process of pharmaceuticals (e.g. pharmacokinetic interference), thus leading to AEs. For example, Ginseng, one of the most widely used dietary supplements, is well known to interact with warfarin. And also, ginsengosides exert a hypoglycaemic effect, which may enhance the actions of oral hypoglycaemic drugs and insulin [2]. Therefore, when these herbs and drugs are used together, possible negative drugherb interaction could happen.
3 The need to concisely report AEs of RCT with TCM drug intervention
AEs associated with the use of TCM should be properly reported as overestimation or underestimation will constitute misinformation for both patients and healthcare providers. In this area, evidence speaks volumes. Where does evidence come from? It comes from clinical practice, especially from clinical trials such as RCTs. It is well known that RCT is an effective tool to determine the efficacy of an intervention on a welldefined disease or a series of symptoms, and also provides valuable evidence regarding safety by identifying the potential risks and AEs associated with an intervention. Therefore, RCTs of TCM should transparently report not only efficacy, but all related AEs in the trial. Failure to report AEs will invite unjustified confidence in the safety of TCM. Sufficient details about AEs should be provided to enable readers to fully understand the safety of the herbs used. In addition, reports of AEs should be interpreted in relation to therapeutic efficacy, method of assessment, and underlying causality on the basis of both TCM theory and conventional medicine, to help readers assess the safety of specific TCM interventions.
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4 Structure for reporting AEs
In order to give readers a comprehensive understanding about the safety of TCM interventions, background information on known or suspected side effects of each CMM constituent in the study intervention, as well as specific outcome assessment on AEs, details of reported AEs, and the interpretation of the AEs should be included in a report of AEs in RCTs of TCM.
4.1 Background information on AEs Before a TCM intervention enters into an RCT, initial analysis and review of the safety of the intervention is necessary. The safety background information of the TCM drug should be briefly summarized. The data may come from literature review or preclinical pharmacology/toxicology testing.
4.2 Specific outcome assessment Outcome measures specific to safety surveillance should be addressed, as well as details regarding other assessments related to treatment efficacy. Selection rationale, concrete assessment method, and reference standards should also be defined and explained. If the occurrence of specific AEs is to be used as one of the terminal evaluation criteria, its underlying rationale should also be determined and described.
4.3 Details of reported AEs All AEs discovered in treatment and control groups, regardless of severity, must be transparently reported. The details should include clear definition of each AE, time of occurrence, frequency in each group, degree of severity, and number of cases who withdrew or reduced their dose due to AEs. If no AEs were reported, authors should declare that "no AEs were reported", instead of not mentioning AEs at all in the RCT report.
4.4 Interpretation All AEs reported should be interpreted, in terms of both TCM theory and conventional medicine, if applicable, including a discussion of the potential underlying causality.
5 Recommendations for revision of CONSORT for TCM
To better reveal the safety issues of CMM intervention, further modifications to the draft of CONSORT for TCM, with the addition of the following descriptive text to the item numbers were indicated and summarized in Table 1.
Table 1 Recommendations for revision of CONSORT for TCM
TopicItemAdditional descriptionBackground2State the AEs of each CMM in the study intervention and explain with the theories of TCM and conventional medicine, as appropriate.Objective3If the trial addresses both efficacy and safety, the objectives should state this.Intervention5Precisely list the method to minimize the toxicity of the intervention (e.g. special preparation, prolonged boiling process, etc), if applicable.State any available information on safety assessment (e.g. acute toxicity test, chronic toxicity, and quality control on contamination, etc).Outcome6List the outcomes specific on safety issue with definition, concrete assessment method (e.g. how, when, and by whom, etc) and standard reference.Address the principles of study termination on safety issue, if applicable. Statistical method12Describe the methods used to present and determine the safety issue. Participant flow13Identify the number of withdrawals or those reducing dosages due to adverse effects in each group.Outcome and estimation17Describe the results with regard to safety for each group and the estimated effect size and its precision (e.g. 95% confidence interval).Ancillary analysis18Describe any subgroup analysis and exploratory analysis on safety issues.Adverse event19Report all AEs of each group in detail (e.g. name with clear definition in terms of TCM and/or Western medical terms, nature, time of occurrence, frequency, any recurrence, and degree of severity). If there are no adverse events to report, explicitly declare "no AEs should be reported".Interpretation20Interpret the adverse effects in terms of TCM theory and conventional medicine, and identify the potential underlying causes and any interaction with comedication, if applicable.Suggest advance study as appropriate.
6 Conclusion
The safety of an intervention is as important as its efficacy. AEs are a significant aspect of drug safety. In order to provide a clear profile of the safety of TCM intervention(s) in an RCT report, reporters should 1) present and discuss any information with regard to safety based on literature review or preclinical studies; 2) concisely describe the assessment protocol; 3) completely list any and all AEs that occurred in their trials; and 4) discuss possible causes. We wish these guidelines can help researchers improve their reporting of AEs and thereby improve the quality of their studies, and also help readers critically evaluate the safety profile of tested interventions.
參考文獻
1 Ernst E. Herbal medicines: balancing benefits and risks. Novartis Found Symp. 2007; 282: 154167.
2 Corns CM. Herbal remedies and clinical biochemistry. Ann Clin Biochem. 2003; 40(pt 5): 489507.
3 Chan TYK, Tam HP, Lai CK, et al. A multidisciplinary approach to the toxicologic problems associated with the use of herbal medicines. Ther Drug Monit. 2005; 27(1): 5357.
4 Wu TX, Li YP, Bian ZX, et al. Consolidated standards for reporting trials of traditional Chinese medicine (CONSORT for TCM). Zhongguo Xun Zheng Yi Xue Za Zhi. 2007; 7(8): 601605. Chinese.
吳泰相, 李幼平, 卞兆祥, 等. 中醫藥臨床隨機對照試驗報告規范(征求意見稿). 中國循證醫學雜志. 2007; 7(8): 601605.
5 Wu TX, Li YP, Bian ZX, et al. Consolidated standards for reporting trials of traditional Chinese medicine (CONSORT for TCM). Zhongguo Xun Zheng Yi Xue Za Zhi. 2007; 7(8): 625630.
6 Ioannidis JPA, Evans SJW, Gtzsche PC, et al. Better reporting of harms in randomized trial: an extension of the CONSORT statement. Ann Intern Med. 2004; 141(10): 781788.
7 Vanherweghem JL, Depierreux M, Tielemans C, et al. Rapidly progressive interstitial renal fibrosis in young women: association with slimming regimen including Chinese herbs. Lancet. 1993; 341(8842): 387391.
8 Yang L, Li XM, Wang SX, et al. Peritubular capillary injury in Chinese herb guanmutonginduced acute tubular necrosis. Zhonghua Nei Ke Za Zhi. 2005; 44(7): 525529. Chinese with abstract in English.
楊莉, 李曉玫, 王素霞, 等. 關木通致急性腎小管壞死患者腎間質微血管病變的研究. 中華內科雜志. 2005; 44(7): 525529.
9 Mo WX. Analysis of 67 cases of kidney failure due to usage of guanmutong. Zhonghua Nei Ke Za Zhi. 2007; 2(4): 524525. Chinese.
莫文先. 67例木通中毒導致腎功能衰竭的分析. 中華內科雜志. 2007; 2(4): 524525.
10 Li D. Literature review of eightyfive cases of allergy due to usage of traditional Chinese medicine. Fujian Zhong Yi Yao . 2007; 38(3): 44. Chinese.
李丹. 85例中藥致過敏反應文獻分析. 福建中醫藥. 2007; 38(3): 44.
11 Chinese Pharmacopoeia Commission. The Pharmacopoeia of People's Republic of China. 2005 ed. Beijing: People's Medical Publishing House. 2005: 132. Chinese.
國家藥典委員會. 中華人民共和國藥典. 2005年版. 北京: 人民衛生出版社. 2005: 132.
12 Shekelle P, Hardy ML, Morton SC, et al. Ephedra and ephedrine for weight loss and athletic performance enhancement: clinical efficacy and side effects. Evid Rep Technol Assess (Summ). 2003; (76): 14.
13 Chen XX, Peng C. Multifactorial research and analysis on toxicity control of lateral root of aconite. Zhonghua Zhong Yi Yao Xue Kan. 2007; 25(4): 680681. Chinese with abstract in English.
陳學習, 彭成. 附子毒性控制的多因素探析. 中華中醫藥學刊. 2007; 25(4): 680681.
14 KangYum E, Oransky SH. Chinese patent medicine as a potential source of mercury poisoning. Vet Hum Toxicol. 1992; 34(3): 235238.
15 Liang SX, Bian ZX, Moher D, et al. Improving the quality of randomized controlled trials in Chinese herbal medicine, part Ⅲ: quality control of Chinese herbal medicine used in randomized controlled trials. Zhong Xi Yi Jie He Xue Bao. 2006; 4(3): 225232. English with abstract in Chinese.
梁士賢, 卞兆祥, Moher D, 等. 提高中草藥隨機對照試驗的質量Ⅲ: 中草藥的質量控制. 中西醫結合學報. 2006; 4(3): 225232.
16 Ernst E, Thompson Coon J. Heavy metals in traditional Chinese medicines: a systematic review. Clin Pharmacol Ther. 2001; 70(6): 497504.
17 Gao ZJ, Zeng BC. Two poisoning case reports on heavy metal medicinal herb preparation. Zhonghua Yu Fang Yi Xue Za Zhi. 1980; 14(2): 117118. Chinese.
高志鈞, 曾炳才. 重金屬中藥制劑中毒二例報告. 中華預防醫學雜志. 1980; 14(2): 117118.
18 Pandha HS. Kirby RS. PCSPES: phytotherapy for prostate cancer. Lancet. 2002; 359(9325): 22132215.
19 Kosty MP. PCSPES: hope or hype? J Clin Oncol. 2004; 22(18): 36573659.
20 School of Chinese Medicine, Hong Kong Baptist University. Easily confused Chinese medicine in Hong Kong. Hong Kong: Chinese Medicine Merchants Association. 2007.
21 Skalli S, Zaid A, Soulaymani R. Drug interactions with herbal medicines. Ther Drug Monit. 2007; 29(6): 679686.
杜甫的名詩范文6
關鍵詞:唐代文學;高考;全國卷
作為教育考試的核心環節,高考卷中的每一道題都是出卷者精心設計的。在全國高考語文卷中,絕大部分的唐代部分都是以詩歌鑒賞為主。放眼近20年的高考全國卷,唐代詩歌鑒賞以杜甫、李白、王維等唐代著名詩人為主,但是近年來一些耳熟能詳的詩歌也開始出現在高考語文卷上。
一、高考詩歌鑒賞中的“名家”
只要一提到唐代詩人,許多人會脫口而出李白、杜甫、白居易等。筆者在整理近20年的高考全國卷時發現,除了一些年份沒有考到唐代文學,基本上這20年里每一年都有會涉及到唐代詩詞的考試,且一些著名詩人的詩歌會換多種形式進行考察,由此我們不難發現,唐代文學的重要性,唐代這些著名詩人重要的歷史價值。
如表1,劉禹錫詩作連續兩年成為高考的題目,且分值都相對較大。詩仙李白的詩作依舊是語文學科的考察重點;杜甫,其作品對我國古典詩歌的影響深淵,考查較多。此外,韓愈、王維、杜牧、白居易、王勃等也考試較多。
近20年的語文高考中,除了以上這些名家,我們也不難發現還有像修睦和李華這樣的作者。李華,作為唐代詩人,其盡管沒有以上幾位詩人的成就,但是其創作的《春行寄興》也是那個時代不可多得的好詩。修睦,所留下的詩句并不多,作為唐末五代的詩人,他的影響力也遠遠不及李白、杜甫等人,但是他的作品也在那個時代引起巨大的轟動。
從表1中,我們不難發現唐代文學的考察都是具有良好的教育意義,這與高考的考察初衷是一致的,無論是韓愈的《師說》、還是李白的《蜀道難》等,都具有較好的教育意義,因此這些詩人的詩作出現在高考卷上也是意料之中的事。
二、高考詩歌鑒賞中的“名家”選擇取向分析
從恢復高考后,高考詩歌鑒賞從原來的探索,到現在形成的命題取向,高考詩歌鑒賞的發展具有積極的現實意義。
首先,其符合語文課程標準。選擇古代詩歌教學,是要培養學生熱愛祖國文學,能夠有效理解和運用祖國的語言文字,并培養學生的預感,提高學生對傳統文化的熱愛。唐代詩歌在我國文學歷史上地位卓越,劉禹錫、李白、杜甫等人的詩歌影響著唐代詩歌的發展方向,同時這些詩人的文學成就對后代的文學發展也具有極大的促進作用。
其次,選擇“名家的作品”或“名詩”進行考察,能夠讓學生了解那個輝煌的歷史,也能夠幫助學生梳理那個朝代的發展方向。而“名詩”考察體現了高考考察的全面性,對于學生全面了解那個時代的文學具有較好的知道意義。
學習是一個發展的過程,應當從發展的角度去看待古代文學的內容價值,也應當去了解那個時代文學創作者的創作思想,用現代的觀念重新審視那些作品,對其存在的積極意義和歷史局限予以客觀的評價。
三、總結
縱觀近20年來的唐代詩歌考察,我們不難領悟出卷者的考察意圖。一個民族精神的源泉就是一個民族的傳統文化,無論是高考復習,還是在日常教學過程中都應當教會學生感受本民族的傳統文化,并抓住規律,在學習名家作品的同時,也不能忽視那些“名詩”背后的作者,這是考點,也是一種學習的態度。
參考文獻: