BACKGROUND & AIMS: :There is a vacuum for a practice discipline of nursing that would enable nurses to articulate the significance of what they do as an essential thread of contemporary healthcare provision. This article is an effort to develop the meaning and possibilities of a practice discipline for nursing. Tuning into the general shift in thought about our human condition across disciplines and nations, we consider features of a participatory paradigm, which, when refocused on the humanness of the health circumstance, informs our approach to a practice discipline. Knowledge is personal and participatory, evolving in the here-and-now of health systems. Research integral to practice and service innovation illustrates the way of looking and talking about a new phase in discipline development. The discipline is relational and creative in practice, evolving in the forums for dialogue. Each one of us as nurses has responsibility in participation.

背景与目标： : 护理实践学科存在真空，这将使护士能够阐明其作为当代医疗保健提供的基本思路的重要性。本文旨在发展护理实践学科的含义和可能性。考虑到跨学科和国家对人类状况的总体转变，我们考虑了参与式范式的特征，当重新关注健康环境的人性时，它为我们的实践学科方法提供了依据。知识是个人和参与性的，在现在的卫生系统中不断发展。实践和服务创新不可或缺的研究说明了看待和谈论学科发展新阶段的方式。该学科在实践中是关系和创造性的，在对话论坛中不断发展。作为护士，我们每个人都有责任参与。

BACKGROUND & AIMS: :Creatine's effects on brain energy metabolism raise the possibility of developing a new therapeutic strategy in depression focusing on the treatment of metabolic hypoactive brain areas. Previous creatine augmentation studies in patients with major depression showed a beneficial effect. Eighteen patients (14 women) with major depression not responding to previous 3 weeks of antidepressant treatment were enrolled into a pilot, dose finding, 4-week double-blind parallel augmentation study where creatine monohydrate 5 or 10 g daily or placebo was added to ongoing SSRIs/SNRIs/NASA treatment. Rating scales included the Hamilton Depression Rating Scale and the Clinical Global Impression Severity scale. Overall, there was no difference between creatine administered at 5 or 10 g daily and its corresponding placebos. Two female patients on creatine augmentation, but none on the placebo, showed early improvement of more than 50% reduction in Hamilton Depression Rating Scale after 2 weeks of creatine treatment. No clinically relevant side effects were reported. This preliminary study seems to suggest that the strategy using creatine augmentation in major depressive women showing no 'real-life response' to 3 weeks of treatment with SSRIs/SNRIs/NASA treatment is of no advantage compared with placebo. However, such creatine augmentation may still induce a more rapid response in a small subgroup of these female patients.

背景与目标： : 肌酸对大脑能量代谢的影响增加了开发一种新的抑郁症治疗策略的可能性，重点是治疗代谢减退的大脑区域。先前对重度抑郁症患者进行的肌酸增强研究显示出有益的效果。18名严重抑郁症患者 (14名女性) 对之前3周的抗抑郁药治疗无反应，参加了一项试点，剂量发现，为期4周的双盲平行增强研究，其中将每日5或10g的肌酸一水合物或安慰剂添加到正在进行的SSRIs/SNRIs/NASA治疗中。评分量表包括汉密尔顿抑郁评分量表和临床全球印象严重程度量表。总体而言，每天5或10g的肌酸与其相应的安慰剂之间没有差异。两名接受肌酸增强治疗的女性患者，但安慰剂组无一例，在2周肌酸治疗后，汉密尔顿抑郁量表的早期改善幅度超过50%。没有临床相关副作用的报道。这项初步研究似乎表明，与安慰剂相比，在严重抑郁症女性中使用肌酸增强的策略对SSRIs/SNRIs/NASA治疗3周没有 “现实反应”。但是，这种肌酸增强仍可能在这些女性患者的一小部分中引起更快的反应。

BACKGROUND & AIMS: :The studies performed confirmed the existence of effects of drug addiction on the processes of discipline and training of soldiers. Soldiers taking drugs have more critical attitudes toward military service obligation and to a greater degree accept the opinion that it is a waste of time for them. Soldiers taking drugs have worse results in general and professional military training.

背景与目标： : 进行的研究证实了吸毒成瘾对士兵纪律和训练过程的影响。吸毒的士兵对服兵役的态度更为严格，并且在更大程度上接受了这样的观点，即这对他们来说是浪费时间。服用毒品的士兵在一般和专业军事训练中效果更差。

BACKGROUND & AIMS: :The impact of nanopathology in medicine necessarily involves also the anatomo-pathological diagnostics, because of the current large spread of nanoparticles in the environment and the wide spectrum of correlated human diseases. The main entrance gates of nanoparticles into the body are respiratory inhalation, gastro-intestinal absorption and injection of polluted drugs. In all these cases, their penetration in the lymphatic or blood streams are possible, with subsequent systemic translocation. Different diseases can be generated by nanoparticles exposure, from a direct contact irritation to the onset of granulomatous diseases. Interestingly, they can also act as endocrine disruptors on the autocrine and paracrine systems. At cellular level, nanoparticles can damage the DNA content leading to a subsequent tumorigenesis. In the forensic setting, they can be searched in case of known exposure to inorganic particulate matter or in case of diseases of unknown origin, from granulomatous reactions to foreign inclusions in neoplastic tissues. The combined physical-histopathological studies allow to relate possible environmental/industrial pollution with the pathology and offer a novel tool for forensic investigations, but, overall, they represent new technical evidences for lawyers to present in a court.

背景与目标： : 由于纳米颗粒在环境中的广泛传播以及相关的人类疾病的广泛传播，因此纳米颗粒在医学中的影响也必然涉及解剖病理学诊断。纳米颗粒进入人体的主要入口是呼吸吸入，胃肠道吸收和注射污染的药物。在所有这些情况下，它们都可能渗透到淋巴或血流中，随后发生全身易位。纳米颗粒暴露可以产生不同的疾病，从直接接触刺激到肉芽肿性疾病的发作。有趣的是，它们还可以在自分泌和旁分泌系统上充当内分泌干扰物。在细胞水平上，纳米颗粒会破坏DNA含量，导致随后的肿瘤发生。在法医环境中，可以在已知暴露于无机颗粒物的情况下或在未知来源的疾病的情况下，从肉芽肿反应到赘生组织中的异物夹杂物进行搜索。结合的物理组织病理学研究可以将可能的环境/工业污染与病理学联系起来，并为法医调查提供了一种新颖的工具，但总的来说，它们代表了律师出庭的新技术证据。

BACKGROUND & AIMS: :Mountain ash (Sorbus decora and S. americana) is used by the Cree Nation of the James Bay region of Quebec (Eeyou Istchee) as traditional medicine. Its potential as an antidiabetic medicine is thought to vary across its geographical range, yet little is known about the factors that affect its antioxidant capacity. Here, we examined metabolite gene expression in relation to antioxidant activity, linking phytochemistry and medicinal potential. Samples of leaf and bark from S. decora and S. americana were collected from 20 populations at four different latitudes. Two genes known to produce antidiabetic substances, flavonol synthase and squalene synthase, were analyzed using quantitative real time PCR. Gene expression was significantly higher for flavonol synthase compared to squalene synthase and increased in the most Northern latitude. Corresponding differences observed in the antioxidant capacity of ethanolic extracts from the bark of Sorbus spp. confirm that plants at higher latitudes increase production of stress-induced secondary metabolites and support Aboriginal perceptions of their higher medicinal potential. Modern genetic techniques such as quantitative real time PCR offer unprecedented resolution to substantiate and scrutinise Aboriginal medicinal plant perception. Furthermore, it offers valuable insights into how environmental stress can trigger an adaptive response resulting in the accumulation of secondary metabolites with human medicinal properties.

背景与目标： : 山灰 (Sorbus decora和S. americana) 被魁北克詹姆斯湾地区的克里族 (Eeyou Istchee) 用作传统医学。它作为抗糖尿病药物的潜力被认为在其地理范围内有所不同，但对影响其抗氧化能力的因素知之甚少。在这里，我们检查了代谢物基因表达与抗氧化活性的关系，将植物化学和药用潜力联系起来。从四个不同纬度的20个种群中收集了来自decora和S. americana的叶子和树皮样品。使用定量实时PCR分析了两个已知产生抗糖尿病物质的基因，黄酮醇合酶和角鲨烯合酶。与角鲨烯合酶相比，黄酮醇合酶的基因表达显着更高，而在最北纬地区则有所增加。从山梨花树皮的乙醇提取物的抗氧化能力观察到相应的差异。确认高纬度地区的植物会增加胁迫诱导的次生代谢产物的产生，并支持原住民对其更高药用潜力的认识。定量实时PCR等现代遗传技术提供了前所未有的分辨率，可以证实和审查原住民药用植物的感知。此外，它为环境压力如何触发适应性反应提供了宝贵的见解，从而导致具有人类药用特性的次生代谢产物的积累。

BACKGROUND & AIMS: :The aim of this longitudinal study was to assess the effect on dental students' grades of participating in a third-year course taught in orthodontics alone versus an interdisciplinary course taught with orthodontics and pediatric dentistry combined. In the five-year dental curriculum at Yeditepe University in Istabul, Turkey, the third-year orthodontic course was taught as a single discipline until 2010, when the course was redesigned as an interdisciplinary course in orthodontics and pediatric dentistry. This retrospective study analyzed all 540 students' grades in orthodontic courses in the third, fourth, and fifth years from 2003-04 to 2014-15 to determine the impact of the third-year course design on students' performance. Students were divided into two cohorts: group A (which experienced the single discipline course, 2003-04 to 2009-10; 181 female, 117 male) and group B (which experienced the combined course, 2010-11 to 2014-15; 152 female, 90 male). In both groups, significant differences were found for the third-, fourth-, and fifth-year orthodontic grades (p<0.05). The grades of the third-year and fifth-year students in 2014-15 were significantly higher than in 2010-11 (p<0.05) in group B. Intergroup comparison showed that the third- and fifth-year grades were significantly higher in group B than in group A (p<0.05). These results suggest that the interdisciplinary delivery of basic knowledge in the third year had facilitated the learning process and deep learning in the more advanced orthodontic courses in the fifth year.

背景与目标： : 这项纵向研究的目的是评估单独参加正畸学课程的三年级课程对牙科学生成绩的影响，而不是将正畸学和儿科牙科相结合的跨学科课程。在土耳其伊斯塔布尔的Yeditepe大学的五年制牙科课程中，第三年的正畸课程是作为单一学科2010年教授的，当时该课程被重新设计为正畸和儿科牙科的跨学科课程。这项回顾性研究分析了2003-04至2014-15年第三，第四和第五年所有540名学生的正畸课程成绩，以确定三年级课程设计对学生成绩的影响。学生分为两个队列: A组 (经历了2003-04至2009-10的单一学科课程; 181女性，117男性) 和B组 (经历了2010-11至2014-15的组合课程; 152女性，90男性)。在两组中，第三，第四和第五年正畸等级均存在显着差异 (p<0.05)。B组2014-15年的三年级和五年级学生的成绩明显高于2010-11年 (p<0.05)。组间比较显示，B组的三年级和五年级明显高于A组 (p<0.05)。这些结果表明，第三年跨学科提供的基础知识促进了第五年更高级的正畸课程的学习过程和深度学习。

BACKGROUND & AIMS: BACKGROUND:Health inequalities that affect indigenous peoples have been recently documented by international organizations such as the United Nations Permanent Forum on Indigenous Issues (UNPFII) and the Pan American Health Organization (PAHO). The Nasa reservation in Iquira (Huila) where this study was conducted has one of the highest infant mortality rates in the country. OBJECTIVE:Understanding community perspectives about the sociocultural determinants of children's health is crucial in order to develop effective and culturally appropriate public health interventions to address this pressing issue. METHODS:This study employed Community-Based Participatory Research (CBPR) as a methodological framework. Community partnerships in the form of local health committees led the process along with the academic team. Group discussions and photovoice were conducted with a criterion sampling of sages, midwives, traditional doctors, traditional massage therapist, traditional pressure taker (pulseadores), health promoters, community authorities, mothers, students, educators and other key community members. RESULTS:Grounded qualitative data analyses suggest a loss in the traditional customs and the credibility of ancestral medicine; a move from autonomy to dependence on external food sources; and increased child neglect and environmental pollution as the primary conditions associated with the increase in preventable diseases, malnutrition, and infant mortality. CONCLUSIONS:Community implications include the need to strengthen child-rearing, food production and nutritional practices in accordance with ancestral knowledge. Institutional support is sought to support the implementation of indigenous communities' life plans as well as to adjust the institutional programs offered to communities in a way that they promote ancestral identity and cultural continuity.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Parents' use of physical discipline has generated controversy related to concerns that its use is associated with adjustment problems such as aggression and delinquency in children. However, recent evidence suggests that there are ethnic differences in associations between physical discipline and children's adjustment. This study examined race as a moderator of the link between physical discipline and adolescent externalizing behavior problems, extending previous research beyond childhood into adolescence and considering physical discipline at multiple points in time. METHODS:A representative community sample of 585 children was followed from pre-kindergarten (age 5) through grade 11 (age 16). Mothers reported on their use of physical discipline in the child's first five years of life and again during grades 6 (age 11) and 8 (age 13). Mothers and adolescents reported on a variety of externalizing behaviors in grade 11 including aggression, violence, and trouble at school and with the police. RESULTS:A series of hierarchical linear regressions controlling for parents' marital status, socioeconomic status, and child temperament revealed significant interactions between physical discipline during the child's first five years of life and race in the prediction of 3 of the 7 adolescent externalizing outcomes assessed and significant interactions between physical discipline during grades 6 and 8 and race in the prediction of all 7 adolescent externalizing outcomes. Regression slopes showed that the experience of physical discipline at each time point was related to higher levels of subsequent externalizing behaviors for European American adolescents but lower levels of externalizing behaviors for African American adolescents. CONCLUSIONS:There are race differences in long-term effects of physical discipline on externalizing behaviors problems. Different ecological niches may affect the manner in which parents use physical discipline, the meaning that children attach to the experience of physical discipline, and its effects on the adjustment of children and adolescents.

背景与目标：

BACKGROUND & AIMS: OBJECTIVES:To develop a new measure of parental discipline of children encompassing a broad array of types of discipline and modes of administration. METHODS:Parents of 12- to 19-month-old children were interviewed using a new 45-item structured survey about discipline in general pediatric clinics in North Carolina and Alabama. Demographic data describing the population studied were linked from another study in which these families were participating. Principal component analysis and confirmatory reliability analysis were used to define subscales and determine which items were retained in the survey. RESULTS:One hundred eighty-two parents were interviewed about disciplinary practices. Disciplinary subscales were robust for a number of disciplinary types (monitoring, verbal communication, modeling behavior, corporal punishment, and ignoring) and modes of administration (follow-through, consistency, positive demeanor, negative demeanor). CONCLUSIONS:The Discipline Survey is a promising new measure of parental discipline. A survey instrument to assess disciplinary practices like the one developed fills a gap and can enhance research methodology for those interested in the effects of interventions on parental discipline.

背景与目标：

BACKGROUND & AIMS: :In a 1991 editorial in The FASEB Journal, Robert W. Krauss commented on a recent report of the Presidential Advisory Committee on the Future of the U.S. Space Program (Augustine report). He concluded that, although a manned mission to Mars with life sciences as the priority was endorsed by the Committee, it failed to deal realistically with one huge gap; biological sciences have never been given high priority. According to Krauss, this left a void that will cripple, perhaps fatally, any early effort to ensure long-term survival on any mission of extended duration. The gap included insufficient flight time for fundamental biological space research and insufficient funds. Krauss expressed his opinions 15 years ago. Have we better knowledge of space biology now? This question becomes more acute now that President George W. Bush recently proposed a manned return to the moon by 2015 or 2020, with the moon to become our staging post for manned missions to Mars. Will we be ready so soon? A review of the progress in the last 15 years suggests that we will not. Because of the Columbia disaster, flight opportunities for biological sciences in shuttle spacelabs and in Space Station laboratories compete with time for engineering problems and construction. Thus, research on gravity, radiation, and isolation loses out to problems deemed to be of higher priority. Radiation in deep space and graded gravity in space with on board centrifuges are areas that must be studied before we undertake prolonged space voyages. Very recent budgetary changes within National Aeronautics and Space Administration threaten to greatly reduce the fundamental space biology funds. Are we ready for a trip to Mars? Like Krauss 15 years ago, I think not for some time.

背景与目标： : 在《FASEB杂志》的1991社论中，罗伯特·W·克劳斯 (Robert W. Krauss) 评论了总统咨询委员会最近关于美国太空计划未来的报告 (奥古斯丁报告)。他得出的结论是，尽管以生命科学为优先事项的载人火星飞行任务得到了委员会的认可，但它未能现实地解决一个巨大的差距。生物科学从未得到高度重视。根据克劳斯 (Krauss) 的说法，这留下了一个空白，可能会致命地削弱任何早期的努力，以确保任何长期任务的长期生存。差距包括基础生物空间研究的飞行时间不足和资金不足。克劳斯15年前就发表了自己的意见。我们现在对空间生物学有更好的了解吗？现在这个问题变得更加尖锐，因为乔治·W·布什总统最近提议载人返回月球2015年或2020，月球成为我们载人火星任务的集结地。我们会这么快就准备好了吗？回顾过去15年的进展表明，我们不会。由于哥伦比亚灾难，航天飞机spacelabs和空间站实验室的生物科学飞行机会与工程问题和建设时间竞争。因此，对重力，辐射和隔离的研究失去了被认为具有更高优先级的问题。在进行长时间的太空航行之前，必须研究深空中的辐射和带有离心机的太空重力。国家航空航天局最近的预算变化有可能大大减少基本的空间生物学资金。我们准备好去火星旅行了吗？就像15年前的克劳斯一样，我认为一段时间没有。

BACKGROUND & AIMS: OBJECTIVE:The OECD countries are facing a set of core challenges; an increasing elderly population; increasing number of chronic and lifestyle-related diseases; expanding scope of what medicine can do; and increasing lack of medical professionals. Pervasive healthcare asks how pervasive computing technology can be designed to meet these challenges. The objective of this paper is to discuss 'pervasive healthcare' as a research field and tries to establish how novel and distinct it is, compared to related work within biomedical engineering, medical informatics, and ubiquitous computing. METHODS:The paper presents the research questions, approach, technologies, and methods of pervasive healthcare and discusses these in comparison to those of other related scientific disciplines. RESULTS:A set of central research themes are presented; monitoring and body sensor networks; pervasive assistive technologies; pervasive computing for hospitals; and preventive and persuasive technologies. Two projects illustrate the kind of research being done in pervasive healthcare. The first project is targeted at home-based monitoring of hypertension; the second project is designing context-aware technologies for hospitals. Both projects approach the healthcare challenges in a new way, apply a new type of research method, and come up with new kinds of technological solutions. 'Clinical proof-of-concept' is recommended as a new method for pervasive healthcare research; the method helps design and test pervasive healthcare technologies, and in ascertaining their clinical potential before large-scale clinical tests are needed. CONCLUSION:The paper concludes that pervasive healthcare as a research field and agenda is novel; it is addressing new emerging research questions, represents a novel approach, designs new types of technologies, and applies a new kind of research method.

背景与目标：

BACKGROUND & AIMS: AIM:The purpose of the present study was to highlight the effects of hospital reform introduced in Norway 2002 on patient rehabilitation. BACKGROUND:The Norwegian hospital reform is an activity-controlled financing system with diagnosis-related groups (DRG). METHOD:A multi-case study with embedded design methods was used. Document analysis and interviews are sources of evidence. RESULTS:The rehabilitation service offered a treatment service that was inadequately funded. The focus of the rehabilitation team was negatively affected by the lack of organization. The different patient groups did not receive optimal and individualized rehabilitation as required by individual treatment plans. There were two different levels of rehabilitation at the hospitals. CONCLUSIONS:The financing system did not provide for a differentiated treatment service tailored to each patient's individual plan, as stipulated by health policy. An increase in the number of patients receiving rehabilitation in the health authorities was not accompanied by an increase in allocated resources, leading to an insufficient overall rehabilitation service. The organizations included in the case study were not those who finance specialized rehabilitation at specialized rehabilitation centres. IMPLICATIONS FOR NURSING MANAGEMENT:Specially trained nurses are strategically placed to shape and influence funding of rehabilitation programmes through leadership.

背景与目标：

BACKGROUND & AIMS: :Based on work conducted by Laurentian University's School of Nursing and Centre for Continuing Education in Sudbury, Ontario, Canada, working in conjunction with community partners, this article looks at the findings of an analysis of nurses' writing activity in a university-level web-based module for evidence of critical thinking using Johns' Model of Structured Reflection (1995). Also considered are student-teacher interactions and discipline-specific writing. The findings suggest that high levels of critical thinking by nurse learners and growth in thinking and writing competence over time can occur in an online setting. Further highlighted are the role of the instructor, assignment design, and support in fostering such development.

背景与目标： : 基于Laurentian大学护理学院和加拿大安大略省萨德伯里继续教育中心与社区合作伙伴合作开展的工作，本文着眼于在大学级别的基于web的模块中分析护士的写作活动的结果，该模块使用约翰斯的结构化反思模型 (1995) 来证明批判性思维。还考虑了学生与教师的互动和针对特定学科的写作。研究结果表明，护士学习者的批判性思维水平很高，随着时间的推移，思维和写作能力的增长可能会在在线环境中发生。进一步强调了讲师，作业设计和支持在促进此类发展中的作用。

BACKGROUND & AIMS: :Although public opinion is important in deciding what is valued by society, governments have determined that scientific expertise is required to evaluate potential environmental effects of genetically modified (GM) crops. We suggest how to evaluate rigorously the environmental effects of GM crops in the context of a scientific investigation. Following a disciplined scientific approach to environmental risk assessment (ERA) for GM crops should help resolve controversy in identifying and addressing risk.

背景与目标： : 尽管公众舆论在决定社会重视什么方面很重要，但政府已经确定需要科学专业知识来评估转基因作物的潜在环境影响。我们建议如何在科学调查的背景下严格评估转基因作物的环境影响。遵循严格的科学方法对转基因作物进行环境风险评估 (ERA)，应有助于解决识别和解决风险方面的争议。

BACKGROUND & AIMS: :Prolonged exposure of humans and experimental animals to the altered gravitational conditions of space flight has adverse effects on the lymphoid and erythroid hematopoietic systems. Although some information is available regarding the cellular and molecular changes in lymphocytes exposed to microgravity, little is known about the erythroid cellular changes that may underlie the reduction in erythropoiesis and resultant anemia. We now report a reduction in erythroid growth and a profound inhibition of erythropoietin (Epo)-induced differentiation in a ground-based simulated microgravity model system. Rauscher murine erythroleukemia cells were grown either in tissue culture vessels at 1 x g or in the simulated microgravity environment of the NASA-designed rotating wall vessel (RWV) bioreactor. Logarithmic growth was observed under both conditions; however, the doubling time in simulated microgravity was only one-half of that seen at 1 x g. No difference in apoptosis was detected. Induction with Epo at the initiation of the culture resulted in differentiation of approximately 25% of the cells at 1 x g, consistent with our previous observations. In contrast, induction with Epo at the initiation of simulated microgravity resulted in only one-half of this degree of differentiation. Significantly, the growth of cells in simulated microgravity for 24 h prior to Epo induction inhibited the differentiation almost completely. The results suggest that the NASA RWV bioreactor may serve as a suitable ground-based microgravity simulator to model the cellular and molecular changes in erythroid cells observed in true microgravity.

背景与目标： : 人类和实验动物长时间暴露于改变的太空飞行重力条件对淋巴和红系造血系统有不利影响。尽管可以获得有关暴露于微重力的淋巴细胞的细胞和分子变化的一些信息，但对可能导致红细胞生成减少和由此导致的贫血的红系细胞变化知之甚少。现在，我们报告了在基于地面的模拟微重力模型系统中红细胞生长的减少和对促红细胞生成素 (Epo) 诱导的分化的深刻抑制。Rauscher鼠红白血病细胞在1 x g的组织培养容器中或在NASA设计的旋转壁容器 (RWV) 生物反应器的模拟微重力环境中生长。在两种条件下均观察到对数增长; 然而，模拟微重力的倍增时间仅为1 x g时的一半。未检测到细胞凋亡的差异。在培养开始时用Epo诱导导致在1xg下约25% 的细胞分化，这与我们先前的观察结果一致。相反，在模拟微重力开始时用Epo诱导仅导致这种分化程度的一半。值得注意的是，在Epo诱导之前，细胞在模拟微重力下生长24小时几乎完全抑制了分化。结果表明，NASA RWV生物反应器可以用作合适的地面微重力模拟器，以模拟在真实微重力下观察到的红系细胞的细胞和分子变化。