BACKGROUND & AIMS: OBJECTIVE:We reviewed our initial experience with robotic thy-roidectomy to identify challenges and limitations of this new surgical approach when applied to a North American population. STUDY DESIGN:Case series. SETTING:Academic institution. SUBJECTS/METHODS:Retrospective review of 18 consecutive robotic thyroid lobectomies performed from February 2010 to April 2012 involving 16 female patients. Two patients underwent robot-assisted completion thyroidectomy a few months following the initial thyroid surgery, one for cancer and the other for goiter. RESULTS:Median age was 47.5 years (range, 18-62 years), and median body mass index was 28.7 (range, 19.4-44.5). Median thyroid nodule size was 2.9 cm (range, 1.1-4.7 cm). All but 1 case (6%) was performed successfully via single axillary incision. There was no conversion to an open approach. Median operative time was 170 minutes (range, 95-220 minutes), and median blood loss was 12.5 mL (range, 5-75 mL). Complications occurred in 4 cases (22%) to include temporary vocal cord pareses (n = 3) and a postoperative hematoma that required exploration. Median hospital stay was 2 days (range, 1-3 days). CONCLUSION:Single-incision transaxillary robotic thyroidectomy can be technically challenging in North American patients with a larger body frame due to difficulty in optimal placement of all 4 robotic instruments via a single axillary incision. All 3 cases of temporary vocal cord paresis occurred early in our experience and may have been due to our relative inexperience with this new approach and associated instrumentation. Other limitations include less than optimal visualization of the recurrent laryngeal nerve in the contralateral lobe as well as poor access to the substernal region. LEVEL OF EVIDENCE:4.

背景与目标： 目的：我们回顾了我们在机器人甲状腺切除术方面的初步经验，以确定在将这种新手术方法应用于北美人群时所面临的挑战和局限性。
研究设计：案例系列。
单位：学术机构。
受试者/方法：回顾性回顾了从2010年2月至2012年4月进行的18例机器人甲状腺叶切除术，涉及16例女性患者。在最初的甲状腺手术后的几个月，两名患者接受了机器人辅助的全甲状腺切除术，其中一名癌症，另一名甲状腺肿。
结果：中位年龄为47.5岁（范围18-62岁），中位体重指数为28.7（范围19.4-44.5）。甲状腺结节中值大小为2.9厘米（范围为1.1-4.7厘米）。除1例（6％）外，其余所有病例均通过单根腋窝切口成功完成。没有转换为开放方法。中位手术时间为170分钟（范围为95-220分钟），中位数失血为12.5毫升（范围为5-75毫升）。 4例（22％）发生并发症，包括暂时性声带轻视（n = 3）和需要探查的术后血肿。中位住院天数为2天（范围为1-3天）。
结论：单身穿刺式腋窝机器人甲状腺切除术在体型较大的北美患者中可能具有技术挑战，因为难以通过单个腋窝切口最佳地放置所有四种机器人器械。在我们的经验中，所有3例临时性声带轻瘫均发生在早期，可能是由于我们相对缺乏这种新方法和相关器械的经验。其他限制包括对侧肺叶中喉返神经的最佳可视化效果欠佳，以及难以接近胸骨下区域。
证据级别：4。

BACKGROUND & AIMS: INTRODUCTION:The International Circumpolar Surveillance network is a population-based surveillance system that collects data on invasive pneumococcal disease (IPD) in Northern Canada. A 7-valent pneumococcal conjugate vaccine was first introduced in some regions of Northern Canada in 2002, followed by 10-valent (2009) and 13-valent (PCV-13) vaccines (2010). A 23-valent polysaccharide (PPV-23) vaccine was first introduced in 1988 for special populations and adults aged 65 years and older. To describe the epidemiology in the context of pneumococcal vaccination programs, we analysed surveillance data from Northern Canada from 1999 to 2010. METHODS:A standardized case report form capturing demographic and clinical information was completed for all IPD cases in Northern Canada meeting the national case definition. Isolates were sent to a reference laboratory for confirmation, serotyping and antimicrobial resistance testing. Both laboratory and epidemiological data were sent to the Public Health Agency of Canada for analysis. Population denominators were obtained from Statistics Canada. RESULTS:From 1999 to 2010, 433 IPD cases were reported (average 36 cases per year). Incidence was greatest among infants aged < 2 years and among those aged 65 years and older, with an average annual incidence of 133 and 67 cases per 100,000 population, respectively. After a peak in incidence in 2008, rates among infants have declined. Incidence rates varied from 2 to 16 times greater, depending on the year, among Aboriginals compared to non-Aboriginals. Hospitalization was reported in 89% of all cases and the case fatality ratio was 6.0%. Clinical manifestations varied, with some patients reporting > 1 manifestation. Pneumonia was the most common (70%), followed by bacteremia/septicaemia (30%) and meningitis (8%). Approximately, 42% of cases aged < 2 years in 2009 and 2010 had serotypes covered by the PCV-13. In addition, the majority (89%) of serotypes isolated in cases aged 65 years and older were included in the PPV-23 vaccine. CONCLUSION:IPD continues to be a major cause of disease in Northern Canadian populations, with particularly high rates among infants and Aboriginals. Continued surveillance is needed to determine the impact of conjugate pneumococcal vaccine programs. Additional studies investigating factors that predispose infants and Aboriginal peoples would also be beneficial.

背景与目标： 简介：国际环极监视网络是一个基于人群的监视系统，收集加拿大北部的侵袭性肺炎球菌疾病（IPD）数据。 2002年在加拿大北部的某些地区首次引入了7价肺炎球菌结合疫苗，随后是10价（2009）和13价（PCV-13）疫苗（2010）。 1988年，针对特殊人群和65岁及以上的成年人首次引入了23价多糖（PPV-23）疫苗。为了描述肺炎球菌疫苗接种计划中的流行病学，我们分析了加拿大北部1999年至2010年的监测数据。
方法：完成了加拿大北部符合国家病例定义的所有IPD病例的标准化病例报告表，包括人口统计和临床信息。将分离物送到参考实验室进行确认，血清分型和抗菌素耐药性测试。实验室和流行病学数据均已发送至加拿大公共卫生局进行分析。人口分母来自加拿大统计局。
结果：从1999年到2010年，报告了433例IPD病例（平均每年36例）。在2岁以下的婴儿中和65岁及65岁以上的婴儿中，发病率最高，每10万人中的年平均发病率分别为133和67例。在2008年发病率达到峰值之后，婴儿的发病率有所下降。与非土著居民相比，土著居民的发病率每年变化2到16倍。据报告，所有病例中有89％住院，病死率为6.0％。临床表现各不相同，有些患者报告> 1种表现。肺炎是最常见的（70％），其次是菌血症/败血病（30％）和脑膜炎（8％）。 2009年和2010年，年龄小于2岁的病例中约有42％具有PCV-13覆盖的血清型。此外，PPV-23疫苗中包括65岁及65岁以上的大多数血清型（89％）。
结论：在加拿大北部人群中，IPD仍然是导致疾病的主要原因，婴儿和土著居民中IPD的发病率特别高。需要继续监测以确定结合的肺炎球菌疫苗计划的影响。进一步调查易患婴儿和原住民的因素也将是有益的。

BACKGROUND & AIMS: OBJECTIVE:To examine lessons learnt from the implementation of five Vanguard initiatives in the North East of England. DESIGN:Data collection comprised semistructured interviews with key informants at each site. SETTING:The study took place across six local authority areas in the North East of England and within six clinical commissioning groups responsible for the delivery of each Vanguard's aims and objectives. PARTICIPANTS:Sixty-six interviewees with participants from five Vanguard initiatives in the North East of England, including senior clinicians, project leads and directors, commissioners, and healthcare managers. RESULTS:While the context for each Vanguard is separate and distinct, there also exists a set of common issues which have a regional dimension. Participants felt that the national programme helped to raise the profile of local change initiatives and also contributed to the wider understanding of regional service integration issues. At the same time our findings demonstrate that all five sites experienced, and were subject to, unrealistic pressure placed on them to deliver outcomes. Of particular concern among all sites was the sheer scale and pace of change occurring at the same time as the National Health Service was being tasked with making significant, if unrealistic, efficiency savings. CONCLUSIONS:It is too early to conclude with any confidence that a successful outcome for the new care models programme will be forthcoming. While early indications show some encouraging signs of promise, the overall context in which the complex and ambitious changes are being implemented remains both fragile and fluid.

背景与目标： 目的：研究在英格兰东北部实施五项先锋计划的经验教训。
设计：数据收集包括对每个站点的关键信息提供者进行半结构化访谈。
地点：该研究在英格兰东北部的六个地方当局地区以及六个临床委托小组中进行，负责交付每个先锋队的目的和目标。
参与者：66名受访者来自英格兰东北部的五项先锋计划的参与者，包括高级临床医生，项目负责人和总监，专员和医疗保健经理。
结果：虽然每个先锋队的背景各不相同，但也存在一系列具有地区性的共同问题。与会者认为，国家方案有助于提高对地方变革举措的认识，也有助于对区域服务一体化问题的更广泛了解。同时，我们的发现表明，所有五个站点都经历了并且承受着施加结果的不切实际的压力。在所有站点中，特别令人担忧的是，在国家卫生服务局（National Health Service）承担着显着（即使不切实际）的效率节省的任务的同时，变化的规模和步伐是巨大的。
结论：现在断定新护理模式计划将取得成功，现在下定论还为时过早。尽管早期迹象显示出一些令人鼓舞的希望迹象，但正在实施复杂而雄心勃勃的变革的总体环境仍然脆弱而多变。

BACKGROUND & AIMS: :We sought to assess if electronic messaging/reminders could increase human papillomavirus (HPV) vaccine completion among adolescents and HPV knowledge among their parents. The study was conducted in two clinics in eastern North Carolina from March 2014-March 2016. Participants included English-speaking and/or Spanish-speaking, uninsured or Medicaid-insured parents and their children (ages 9-17). Intervention participants received text/email appointment reminders and education messages and controls received standard-of-care. The final sample included 257 parent-child dyads. Most identified as Black (60%) or Hispanic (28%). Completion rates for intervention and control groups were similar for HPV dose 2 (65% vs. 65%) and HPV dose 3 (35% vs. 30%), respectively. Although knowledge change was higher for the intervention group, this difference was not statistically significant. Those who reported provider vaccine recommendation were 1.8 times more likely to complete the series. Electronic reminders to promote vaccine completion were not effective in this population. More research is needed.

背景与目标： ：我们试图评估电子消息传递/提醒是否可以提高青少年中人乳头瘤病毒（HPV）疫苗的接种率以及其父母中HPV的知识。该研究于2014年3月至2016年3月在北卡罗莱纳州东部的两家诊所进行。参与者包括讲英语和/或说西班牙语，没有保险或有医疗补助的父母及其子女（9-17岁）。干预参与者收到了文本/电子邮件约会提醒，教育信息和控件收到了护理标准。最终样本包括257个亲子二元组。多数被确定为黑人（60％）或西班牙裔（28％）。 HPV剂量2（65％比65％）和HPV剂量3（35％比30％）的干预组和对照组的完成率相似。尽管干预组的知识变化较高，但这种差异在统计学上并不显着。报告提供者疫苗推荐的人群完成该系列疫苗的可能性是其1.8倍。促进疫苗完成的电子提醒在该人群中无效。需要更多的研究。

BACKGROUND & AIMS: :We have conducted a systematic review to update available information on plasmid-mediated colistin resistance (mobilized colistin resistance [mcr]) genes in North African countries. We have searched the articles of PubMed, Scopus, and Web of Science databases reporting plasmid-mediated colistin resistance bacteria isolated in North African countries. After searching and selection, 30 studies that included 208 mcr-positive isolates were included. Different mcr-positive strains frequencies were recorded and ranged from 2% in clinical isolates to 12.3% in environmental samples. Escherichia coli was the predominant species recorded and these microorganisms showed high resistance to ciprofloxacin and cotrimoxazole. IncHI2 plasmids are probably the key vectors responsible for the dissemination of mcr genes in these countries. This review highlighted that the mcr-positive isolates are circulating in different ecological niches with different frequencies. Therefore, actions should be implemented to prevent the dissemination of the mcr genes within and outside of these countries, such as microbiological and molecular surveillance programs and restriction use of colistin in farming.

背景与目标： ：我们进行了系统的综述，以更新北非国家中质粒介导的大肠菌素抗性（动员大肠菌素抗性[mcr]）基因的可用信息。我们搜索了PubMed，Scopus和Web of Science数据库的文章，这些文章报告了在北非国家分离的质粒介导的大肠菌素抗性细菌。经过搜索和选择，纳入了包括208个mcr阳性分离株的30个研究。记录了不同的mcr阳性菌株频率，范围从临床分离株的2％到环境样品的12.3％。大肠杆菌是记录的主要物种，这些微生物显示出对环丙沙星和卡曲美唑的高抗性。 IncHI2质粒可能是在这些国家/地区传播mcr基因的关键载体。这篇综述强调了mcr阳性分离株在不同生态位中以不同的频率传播。因此，应采取行动防止在这些国家内外传播mcr基因，例如微生物和分子监测计划以及限制大肠菌群的使用。

BACKGROUND & AIMS: OBJECTIVES:Transcutaneous bowel sonography is a nonionizing imaging modality used in inflammatory bowel disease. Although available in Europe, its uptake in North America has been limited. Since the accuracy of bowel sonography is highly operator dependent, low-volume centers in North America may not achieve the same diagnostic accuracy reported in the European literature. Our objective was to determine the diagnostic accuracy of bowel sonography in a nonexpert low-volume center. METHODS:All cases of bowel sonography at a single tertiary care center during an 18-month period were reviewed. Bowel sonography was compared with reference standards, including small-bowel follow-through, computed tomography, magnetic resonance imaging, colonoscopy, and surgical findings. RESULTS:A total of 103 cases were included for analysis during the study period. The final diagnoses included Crohn disease (72), ulcerative colitis (8), hemolytic uremic syndrome (1), and normal (22). The sensitivity and specificity of bowel sonography for intestinal wall inflammation were 87.8% and 92.6%, respectively. In the subset of patients who had complications of Crohn disease, the sensitivity and specificity were 50% and 100% for fistulas and 14% and 100% for strictures. One patient had an abscess, which was detected by bowel sonography. Abnormal bowel sonographic findings contributed to the escalation of treatment in 55% of cases. CONCLUSIONS:Bowel sonography for inflammatory bowel disease can be performed in low-volume centers and provides diagnostic accuracy for luminal disease comparable with published data, although it is less sensitive for complications of Crohn disease.

背景与目标： 目的：经皮肠超声检查是一种用于炎症性肠病的非电离成像方式。尽管在欧洲有售，但其在北美的使用受到限制。由于肠超声检查的准确性在很大程度上取决于操作员，因此北美的小容量医疗中心可能无法达到欧洲文献中报告的诊断准确性。我们的目标是确定非专业小剂量中心的肠超声检查的诊断准确性。
方法：回顾了18个月内在一家三级护理中心进行肠超声检查的所有病例。将肠超声检查与参考标准进行比较，包括小肠随访，计算机断层扫描，磁共振成像，结肠镜检查和手术结果。
结果：在研究期间共纳入103例病例进行分析。最终诊断包括克罗恩病（72），溃疡性结肠炎（8），溶血性尿毒症综合征（1）和正常（22）。肠超声检查对肠壁炎症的敏感性和特异性分别为87.8％和92.6％。在患有克罗恩病并发症的患者子集中，对瘘管的敏感性和特异性分别为50％和100％，对于狭窄则分别为14％和100％。一名患者脓肿，经肠超声检查发现。肠超声检查结果异常有助于55％的病例升级。
结论：炎症性肠病的肠镜检查可以在小容量的中心进行，尽管对克罗恩病的并发症敏感性较低，但可以提供与已发表的数据相媲美的腔内疾病的诊断准确性。

BACKGROUND & AIMS: :The area of mobile technologies applied to health (mHealth) is a growing worldwide trend that has generated enormous expectations for the mitigation of problems related to medical services delivery and public health stemming from a lack of resources and the limited number of specialists. The numerous opportunities offered by mobile technologies, together with their ease of use, have attracted the interest both of governments and universities. This is the case of the Ibero-American Mobile Technologies and Health Network (CYTED-RITMOS, Spanish acronym). As a result of the network's first year of activity, in October 2015 the RITMOS International Workshop was held in Barcelona to present the priority areas in Latin America where research, development, and innovation (R&D+i) projects on mobile health could be carried out and possible solutions found. The objective of this article is to present the potentialities and applicability of mHealth in the Region of the Americas.

背景与目标： ：应用于健康的移动技术（mHealth）领域正在发展，在全球范围内，由于缺乏资源和专家人数有限，人们对减轻与医疗服务提供和公共卫生有关的问题抱有极大的期望。移动技术所带来的众多机遇及其易用性吸引了政府和大学的兴趣。伊比利亚美洲移动技术和卫生网络（CYTED-RITMOS，西班牙首字母缩写）就是这种情况。作为网络第一年的活动的结果，2015年10月，RITMOS国际研讨会在巴塞罗那举行，介绍了拉丁美洲的优先领域，可以在该领域开展有关移动医疗的研究，开发和创新（R＆D i）项目，以及找到可能的解决方案。本文的目的是介绍移动医疗在美洲地区的潜力和适用性。

BACKGROUND & AIMS: BACKGROUND:Characterisation of risk groups who may benefit from pneumococcal vaccination is essential for the generation of recommendations and policy. METHODS:We reviewed the literature to provide information on the incidence and risk of invasive pneumococcal disease (IPD) in at-risk children in Europe and North America. The PubMed database was searched using predefined search terms and inclusion/exclusion criteria for papers reporting European or North American data on the incidence or risk of IPD in children with underlying medical conditions. RESULTS:Eighteen references were identified, 11 from North America and 7 from Europe, with heterogeneous study methods, periods and populations. The highest incidence was seen in US children positive for human immunodeficiency virus infection, peaking at 4167 per 100,000 patient-years in 2000. Studies investigating changes in incidence over time reported decreases in the incidence of IPD between the late 1990s and early 2000s. The highest risk of IPD was observed in children with haematological cancers or immunosuppression. Overall, data on IPD in at-risk children were limited, lacking incidence data for a wide range of predisposing conditions. There was, however, a clear decrease in the incidence of IPD in at-risk children after the introduction of 7-valent pneumococcal conjugate vaccine into immunisation programmes, as previously demonstrated in the general population. CONCLUSION:Despite the heterogeneity of the studies identified, the available data show a substantial incidence of IPD in at-risk children, particularly those who are immunocompromised. Further research is needed to determine the true risk of IPD in at-risk children, particularly in the post-PCV period, and to understand the benefits of vaccination and optimal vaccination schedules.

背景与目标： 背景：可能从肺炎球菌疫苗接种中受益的风险人群的表征对于产生建议和政策至关重要。
方法：我们回顾了文献，以提供有关欧洲和北美高危儿童的侵袭性肺炎球菌疾病（IPD）的发生率和风险的信息。使用预定义的搜索词和纳入/排除标准对PubMed数据库进行了搜索，以检索报告欧洲或北美患有基础疾病的儿童中IPD发生率或风险的数据。
结果：共确定了18篇参考文献，其中11篇来自北美，7篇来自欧洲，其研究方法，时期和人群各不相同。在人类免疫缺陷病毒感染呈阳性的美国儿童中发生率最高，在2000年达到峰值，每10万患者年中有4167名。调查随时间变化的研究报告说，在1990年代末至2000年代初，IPD发生率下降。在患有血液系统癌症或免疫抑制的儿童中，发生IPD的风险最高。总体而言，高危儿童的IPD数据有限，缺乏各种易患病情况的发病率数据。但是，将7价肺炎球菌结合疫苗引入免疫接种计划后，高危儿童IPD发生率明显下降，这在以前的一般人群中已得到证实。
结论：尽管已确定研究的异质性，但现有数据显示高危儿童，特别是免疫受损儿童的IPD发生率很高。需要进一步的研究来确定高危儿童中IPD的真正风险，尤其是在PCV后时期，并了解疫苗接种的好处和最佳的疫苗接种时间表。

BACKGROUND & AIMS: BACKGROUND:Injections can transmit infections such as human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV), and precipitate poliomyelitis. Complications such as injection abscesses and nerve damage may also occur. It is estimated that 50% of the injections given in developing countries are unsafe. However, limited information is available from India. We planned a pilot study to assess the prevalence of injection use and the knowledge of the community and private medical practitioners (PMPs) about injection use. METHODS:One in every four houses in the village under study was selected by systematic random sampling. One adult (> 18 years) respondent in the family was asked questions about family members receiving injections in the past 6 months. Nine PMPs were interviewed about their knowledge and practices regarding injection use. RESULTS:In the past six months, 1280 family members in 285 houses received 1575 injections (2.46 injections per person per year). About 35% had received at least one injection in the past 6 months. Children below 5 years received 3.1 injections/child/year of which about 60% were preventive. On their last visit to a health facility, 55% of the subjects were given injections using disposable syringes. About 45% of the 285 respondents knew that diseases could be spread by improper use of injections. While 18% of the respondents said they would prefer injections, 54% preferred oral medications if both were equally effective. After being told the average cost of disposable needles and syringes, 92% of the respondents were willing to buy them. None of the 9 PMPs practising in the village were formally trained in modern medicine. On the day of observation, 18 of 58 patients (30%) seen by PMPs were given injections. Three injections were observed and though they were all given with disposable syringes, the technique of administration did not follow standard guidelines in any. Two PMPs did not know of any disease transmitted by injections. The syringes were usually thrown in a nearby drain or outside the village. Four PMPs said that patients themselves did not ask for injections. CONCLUSION:The use of injections in the study area was high. The PMPs were not only giving a high number of injections but the technique of administration was also wrong. The community was less likely to ask for injections on their own but was willing to buy disposable syringes and needles. The awareness about the risk of injections was low.

背景与目标： 背景：注射液可传播人类免疫缺陷病毒（HIV），乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）等感染，并导致脊髓灰质炎。也可能发生并发症如注射脓肿和神经损伤。据估计，在发展中国家注射的50％是不安全的。但是，印度提供的信息有限。我们计划进行一项试点研究，以评估注射使用的流行程度以及社区和私人执业医师（PMP）关于注射使用的知识。
方法：通过系统随机抽样，在研究的村庄中每四间房屋中选择一个。在家庭中一名成年人（> 18岁）的受访者被问到有关家庭成员在过去6个月中接受注射的问题。采访了九名PMP，了解他们在注射方面的知识和做法。
结果：在过去六个月中，在285个房屋中的1280个家庭成员接受了1575次注射（每人每年2.46次注射）。在过去的6个月中，约35％的人至少接受过一次注射。 5岁以下的儿童/儿童/年接受3.1针注射，其中约60％是预防性的。在他们最后一次访问医疗机构时，有55％的受试者使用了一次性注射器进行注射。 285名受访者中约有45％知道，不当使用注射剂可能会传播疾病。尽管18％的受访者表示他们更喜欢注射剂，但54％的受访者表示如果两者都同样有效，他们更喜欢口服药物。在被告知一次性针头和注射器的平均成本后，有92％的受访者愿意购买它们。该村的9名PMP均未接受过现代医学的正式培训。在观察当天，在接受PMP治疗的58位患者中，有18位（30％）进行了注射。观察到了三个注射剂，尽管它们都是用一次性注射器注射的，但给药技术均未遵循标准指南。两名PMP不知道注射引起的任何疾病。通常将注射器扔到附近的排水沟或村庄外。四个PMP表示患者本身没有要求打针。
结论：研究区域的注射剂使用率很高。 PMPs不仅要进行大量注射，而且给药技术也是错误的。社区不太可能自行要求打针，但愿意购买一次性注射器和针头。对注射风险的认识很低。

BACKGROUND & AIMS: :We conducted a study on 152 patients with multiple sclerosis (MS) who were born in North Africa and migrated to France. Information was obtained from patients on common childhood infections. We found that, in most cases, common childhood illnesses occurred before migration, but these infections occurred at later ages when the patients were in France: the mean differences were equal to 3 years for measles, 2.1 years for chickenpox, and 4.5 years for mumps. In comparison with data available for the general populations of Algeria and France, the mean ages of childhood infections, and particularly measles, were higher in MS patients. Data confirm that, wherever they live, MS patients tend to have childhood infections at a relatively late age and suggest that migration delays the age of viral infections. This might be one of the possible explanations for the effect of migration on the risk of MS.

背景与目标： ：我们对出生于北非并移居法国的152例多发性硬化症（MS）患者进行了研究。从患者那里获得了有关常见儿童期感染的信息。我们发现，在大多数情况下，儿童时期的常见疾病是在迁徙之前发生的，但是这些感染发生在法国患者晚期，即：麻疹的平均差异等于3岁，水痘的平均差异等于2.1岁，腮腺炎的平均差异等于4.5岁。与可用于阿尔及利亚和法国普通人群的数据相比，MS患者的儿童感染（尤其是麻疹）平均年龄更高。数据证实，无论身在何处，MS患者都倾向于在相对较晚的年龄段感染儿童，这表明迁移会延迟病毒感染的年龄。这可能是迁移对MS风险影响的可能解释之一。

BACKGROUND & AIMS: :In areas of the North Pacific that are largely free of overfishing, climate regime shifts - abrupt changes in modes of low-frequency climate variability - are seen as the dominant drivers of decadal-scale ecological variability. We assessed the ability of leading modes of climate variability [Pacific Decadal Oscillation (PDO), North Pacific Gyre Oscillation (NPGO), Arctic Oscillation (AO), Pacific-North American Pattern (PNA), North Pacific Index (NPI), El Niño-Southern Oscillation (ENSO)] to explain decadal-scale (1965-2008) patterns of climatic and biological variability across two North Pacific ecosystems (Gulf of Alaska and Bering Sea). Our response variables were the first principle component (PC1) of four regional climate parameters [sea surface temperature (SST), sea level pressure (SLP), freshwater input, ice cover], and PCs 1-2 of 36 biological time series [production or abundance for populations of salmon (Oncorhynchus spp.), groundfish, herring (Clupea pallasii), shrimp, and jellyfish]. We found that the climate modes alone could not explain ecological variability in the study region. Both linear models (for climate PC1) and generalized additive models (for biology PC1-2) invoking only the climate modes produced residuals with significant temporal trends, indicating that the models failed to capture coherent patterns of ecological variability. However, when the residual climate trend and a time series of commercial fishery catches were used as additional candidate variables, resulting models of biology PC1-2 satisfied assumptions of independent residuals and out-performed models constructed from the climate modes alone in terms of predictive power. As measured by effect size and Akaike weights, the residual climate trend was the most important variable for explaining biology PC1 variability, and commercial catch the most important variable for biology PC2. Patterns of climate sensitivity and exploitation history for taxa strongly associated with biology PC1-2 suggest plausible mechanistic explanations for these modeling results. Our findings suggest that, even in the absence of overfishing and in areas strongly influenced by internal climate variability, climate regime shift effects can only be understood in the context of other ecosystem perturbations.

背景与目标： ：在北太平洋地区基本上没有过度捕捞的地区，气候制度转变-低频气候变异模式的突然变化-被视为十年尺度生态变异的主要驱动因素。我们评估了主要的气候变化模式的能力[太平洋年代际振荡（PDO），北太平洋涡旋振荡（NPGO），北极涛动（AO），太平洋北美模式（PNA），北太平洋指数（NPI），厄尔尼诺（ElNiño） -南方涛动（ENSO）]解释了北太平洋两个生态系统（阿拉斯加湾和白令海）的十年尺度（1965-2008）气候和生物变异性模式。我们的响应变量是四个区域气候参数的第一主要成分（PC1）[海表温度（SST），海平面压力（SLP），淡水输入，冰盖]和36个生物时间序列中的1-2个PC [生产鲑鱼（Oncorhynchus spp。），底层鱼，鲱鱼（Clupea pallasii），虾和水母的数量或丰度]。我们发现，仅气候模式并不能解释研究区域的生态变异性。仅调用气候模式的线性模型（针对气候PC1）和广义加性模型（针对生物学PC1-2）都产生了具有显着时间趋势的残差，这表明这些模型未能捕捉到生态变异的连贯模式。但是，当将剩余气候趋势和商业捕鱼量的时间序列用作其他候选变量时，生物学PC1-2的所得模型将满足独立残差的假设，并且仅凭气候模式就可预测功率而言，其表现模型将胜于预期。通过效应量和赤池权重的度量，残留的气候趋势是解释生物学PC1变异性的最重要变量，而商业捕获则是生物学PC2的最重要变量。与生物学PC1-2紧密相关的生物分类的气候敏感性和开发历史模式为这些建模结果提出了合理的机理解释。我们的发现表明，即使在没有过度捕捞的情况下，以及在受内部气候变异性强烈影响的地区，也只能在其他生态系统扰动的背景下才能理解气候变化的影响。

BACKGROUND & AIMS: INTRODUCTION:25 years ago was first reported in Cuba and in the western hemisphere an emergent disease: eosinophilic meningoencephalitis due to Angiostrongylus cantonensis larvae. AIM:To collect in a summary form the accumulated experience and the findings of the study of this parasitosis during the period in the Western hemisphere. DEVELOPMENT AND CONCLUSIONS:There have been collected the first evidences, the parasitological and malacological findings, the experimental and molecular studies on immunology and neuroimmunology, the clinic-pathological findings in children and adults with the particularities of this diseases in our environment with special emphasis in the never-before scientific findings reported. It has been documented the testimony, the main findings among the malacological studies, the role of the immunoglobulin E and the mechanism involved in the central nervous system, the intrathecal synthesis patterns of immunoglobulins and the clinical elements in children and adults.

背景与目标： 简介：25年前首次在古巴和西半球报道了一种新出现的疾病：由于广州管圆线虫幼虫引起的嗜酸性脑膜脑炎。
目的：以汇总的形式收集西半球时期该寄生虫病的积累经验和研究结果。
发展与结论：收集了第一批证据，寄生虫学和乳汁学发现，免疫学和神经免疫学的实验和分子研究，儿童和成人的临床病理学发现，特别是在我们环境中这种疾病的特殊性报告了前所未有的科学发现。已有证词，乳汁学研究的主要发现，免疫球蛋白E的作用和中枢神经系统的参与机制，免疫球蛋白的鞘内合成模式以及儿童和成人的临床要素的文献证明。

BACKGROUND & AIMS: Objective:Characterize areas of interinstitutional cooperation and converging health agendas of the Pan American Health Organization/World Health Organization (PAHO/WHO), the Health Council of the Union of South American Nations (UNASUR), and the Amazon Cooperation Treaty Organization (ACTO) in South America based on social determinants of health. Methods:A qualitative study based on official documentary sources from the three organizations, using a comparative analysis of the health agendas of these agencies and the Rio Political Declaration on Social Determinants of Health (2011). Information was systematized using an analytical matrix that identifies convergences in the respective agendas. Results:Development of the health agendas of these agencies is influenced by various international forces such as Member States' foreign policy, international cooperation strategies and models, and the institutions' political and strategic guidelines. These agendas reveal efforts to strengthen blocs, cooperation mechanisms, and coordinated programmatic actions. Conclusions:The agendas of PAHO/WHO, the UNASUR Health Council, and ACTO point towards opportunities for convergence in various programmatic areas, emphasizing social determinants of health. Based on the overall agreements of the Rio Declaration as an analytical framework with recommendations in five decision-making spheres, structural cooperation actions can be carried out in the region's countries, jointly mediated by these agencies.

背景与目标： 目标：确定泛美卫生组织/世界卫生组织（PAHO / WHO），南美国家联盟卫生委员会（UNASUR）和亚马逊合作条约组织（ACTO）的机构间合作领域和融合卫生议程的特征在南美基于健康的社会决定因素。
方法：基于对这三个组织的卫生议程进行的比较分析以及对这三个组织的卫生议程的里约政治宣言（2011年）的定性研究，对这三个组织的卫生议程进行比较。信息通过分析矩阵系统化，该矩阵确定了各个议程中的趋同点。
结果：这些机构的卫生议程的制定受到各种国际力量的影响，例如会员国的外交政策，国际合作战略和模式以及机构的政治和战略指导方针。这些议程揭示了为加强集团，合作机制和协调的计划行动所做的努力。
结论：泛美卫生组织/世卫组织，UNASUR卫生理事会和ACTO的议程指出了在各个计划领域融合的机会，强调了健康的社会决定因素。根据《里约宣言》的总体协定作为一个分析框架，并在五个决策领域提出建议，在这些机构的共同推动下，可以在该区域各国采取结构性合作行动。

BACKGROUND & AIMS: :A conceptual framework is presented, expressing the relationship between food availability and the food and nutritional status of a population. As element of the model, the generation and transfer of appropriate food technologies were included. Based on the conceptual framework, three successful cases of food technology transfer in the Central American area were analyzed. The most important aspects of each case were identified, and a critical review of the characteristics and conditions required to generate and transfer appropriate technologies, was carried out. An inventory was made of those factors which are essential for a food technology to be appropriate; this analysis resulted in the postulation of a model describing the life cycle of appropriate food technologies. On these bases, several guidelines are postulated, which could constitute a conceptual framework to help guide actions in the generation and transference of appropriate food technologies in Central America and Panama. Essential elements of the proposed framework are: identification and characterization of the problem of the group of "users" of the technology; problem solution by a multidisciplinary group; test of the technology and evaluation of its feasibility (technical, economical, political, social and cultural), and controlled transference to the group of "users".

背景与目标： ：提出了一个概念框架，表达了粮食供应与人口粮食和营养状况之间的关系。作为模型的组成部分，包括了适当食品技术的产生和转让。在概念框架的基础上，分析了中美洲地区成功进行食品技术转让的三个案例。确定了每个案例的最重要方面，并对产生和转让适当技术所需的特征和条件进行了严格审查。对适当的食品技术必不可少的那些因素进行了盘点；该分析得出了描述适当食品技术生命周期的模型的假设。在此基础上，提出了几项准则，这些准则可以构成一个概念框架，以帮助指导中美洲和巴拿马有关适当食品技术的产生和转让的行动。拟议框架的基本要素是：确定和表征技术“用户”群体的问题；多学科小组的问题解决方案；测试技术并评估其可行性（技术，经济，政治，社会和文化），并控制向“用户”组的转移。

BACKGROUND & AIMS: -2

背景与目标： -2