BACKGROUND & AIMS: BACKGROUND:Abnormal respiratory rates are one of the first indicators of clinical deterioration in emergency department(ED) patients. Despite the importance of respiratory rate observations, this vital sign is often inaccurately recorded on ED observation charts, compromising patient safety. Concurrently, there is a paucity of research reporting why this phenomenon occurs. OBJECTIVE:To develop a substantive theory explaining ED registered nurses' reasoning when they miss or misreport respiratory rate observations. DESIGN:This research project employed a classic grounded theory analysis of qualitative data. PARTICIPANTS:Seventy-nine registered nurses currently working in EDs within Australia. Data collected included detailed responses from individual interviews and open-ended responses from an online questionnaire. METHODS:Classic grounded theory (CGT) research methods were utilised, therefore coding was central to the abstraction of data and its reintegration as theory. Constant comparison synonymous with CGT methods were employed to code data. This approach facilitated the identification of the main concern of the participants and aided in the generation of theory explaining how the participants processed this issue. RESULTS:The main concern identified is that ED registered nurses do not believe that collecting an accurate respiratory rate for ALL patients at EVERY round of observations is a requirement, and yet organizational requirements often dictate that a value for the respiratory rate be included each time vital signs are collected. The theory 'Rationalising Transgression', explains how participants continually resolve this problem. The study found that despite feeling professionally conflicted, nurses often erroneously record respiratory rate observations, and then rationalise this behaviour by employing strategies that adjust the significance of the organisational requirement. These strategies include; Compensating, when nurses believe they are compensating for errant behaviour by enhancing the patient's outcome; Minimalizing, when nurses believe that the patient's outcome would be no different if they recorded an accurate respiratory rate or not and; Trivialising, a strategy that sanctions negligent behaviour and occurs when nurses 'cut corners' to get the job done. Nurses' use these strategies to titrate the level ofemotional discomfort associated with erroneous behaviour, thereby rationalising transgression CONCLUSION: This research reveals that despite continuing education regarding gold standard guidelines for respiratory rate collection, suboptimal practice continues. Ideally, to combat this transgression, a culture shift must occur regarding nurses' understanding of acceptable practice methods. Nurses must receive education in a way that permeates their understanding of the relationship between the regular collection of accurate respiratory rate observations and optimal patient outcomes.

背景与目标： 背景：呼吸频率异常是急诊科（ED）患者临床恶化的首批指标之一。尽管进行呼吸频率观察很重要，但该生命体征常常不准确地记录在ED观察图上，从而危及患者的安全。同时，很少有研究报告这种现象发生的原因。
目的：建立一个实质性的理论来解释急诊室注册护士错过或误报呼吸频率观察值时的推理。
设计：该研究项目对定性数据进行了经典的扎根理论分析。
参与者：目前在澳大利亚的急诊室工作的九十九名注册护士。收集的数据包括个人访谈的详细回答和在线问卷的不限成员名额的回答。
方法：由于采用了经典的扎根理论（CGT）研究方法，因此编码对于数据的抽象及其作为理论的重新整合至关重要。与CGT方法同义的常量比较用于编码数据。这种方法有助于确定参与者的主要关注点，并有助于产生解释参与者如何处理此问题的理论。
结果：确定的主要关注点是，急诊注册护士并不认为需要在每一轮观察中为所有患者收集准确的呼吸频率，但是组织要求通常要求每次重要时都应包括呼吸频率值收集迹象。 “合理化违法行为”理论解释了参与者如何持续解决这一问题。该研究发现，尽管感到职业上有矛盾，但护士经常会错误地记录呼吸频率的观察结果，然后通过采用可调整组织要求重要性的策略来合理化这种行为。这些策略包括：补偿：当护士认为他们通过提高患者的治疗效果来补偿错误的行为时；当护士认为患者记录正确的呼吸频率与否时，结局没有什么不同，并且最小化；琐事化是一种惩罚过失行为的策略，当护士“偷工减料”完成工作时就会发生。护士使用这些策略来减轻与错误行为有关的情绪不适水平，从而使过犯合理化。结论：这项研究表明，尽管继续接受有关呼吸频率收集的金标准指南的教育，但最佳实践仍在继续。理想情况下，为了应对这种违法行为，必须在护士对可接受的练习方法的理解上发生文化转变。护士必须接受一定程度的教育，以使他们了解定期收集的准确呼吸频率观察值与患者最佳结局之间的关系。

BACKGROUND & AIMS: :Numerous debilitating human disorders result from protein misfolding and amyloid formation. Despite the grave nature of these maladies, our understanding of the structural mechanism of fibril assembly is limited. Of paramount importance is the need to identify and characterize oligomeric species formed early during fibril assembly, so that the nature of the initiating assembly mechanism can be revealed and species that may be toxic to cells identified. However, the transient nature of early oligomeric species, combined with their heterogeneity and instability, has precluded detailed analysis to date. Here, we have used electrospray ionisation mass spectrometry (ESI-MS), complemented by analytical ultracentrifugation (AUC) and measurements of thioflavin-T fluorescence, to monitor the early stages of assembly of amyloid-like fibrils formed from human beta-2-microglobulin (beta2m) in vitro. We show that worm-like fibrils that form with nucleation-independent kinetics assemble by a mechanism consistent with monomer addition, with species ranging from monomer to > or = 13-mer being identified directly and uniquely as transient assembly intermediates. By contrast, only monomers, dimers, trimers and tetramers are observed during nucleated growth, which leads to the formation of long straight fibrils. The results highlight the unique power of non-covalent ESI-MS to identify protein assembly intermediates in complex heterogeneous systems and demonstrate its great potential to identify and characterise individual species formed early during amyloid assembly.

背景与目标： ：许多使人衰弱的疾病源于蛋白质错误折叠和淀粉样蛋白形成。尽管这些疾病具有严重的性质，但是我们对原纤维组装的结构机理的理解是有限的。最重要的是需要鉴定和表征在原纤维组装过程中早期形成的寡聚物种，以便可以揭示起始组装机制的性质并鉴定可能对细胞有毒的物种。然而，迄今为止，早期寡聚物种的短暂性质，加上其异质性和不稳定性，已使详细分析无法进行。在这里，我们使用了电喷雾电离质谱（ESI-MS），并通过分析超速离心（AUC）和硫代黄素-T荧光的测量，来监测由人β-2-微球蛋白形成的淀粉样蛋白原纤维组装的早期阶段。 （beta2m）体外。我们显示，与成核无关的动力学形式形成的蠕虫状原纤维通过与单体加成一致的机制组装，从单体到>或= 13-mer的物质被直接和唯一地识别为瞬态组装中间体。相反，在成核生长期间仅观察到单体，二聚体，三聚体和四聚体，这导致长直原纤维的形成。结果突出了非共价ESI-MS识别复杂异质系统中蛋白质装配中间体的独特能力，并证明了其鉴定和表征淀粉样蛋白装配早期形成的单个物种的巨大潜力。

BACKGROUND & AIMS: AIM:To observe the effect of targeted therapy with 64-slice spiral computed tomography (CT) combined with cryoablation for liver cancer. METHODS:A total of 124 patients (142 tumors) were enrolled into this study. According to the use of dual-slice spiral CT or 64-slice spiral CT as a guide technology, patients were divided into two groups: dual-slice group (n = 56, 65 tumors) and 64-slice group (n = 8, 77 tumors). All patients were accepted and received targeted therapy by an argon-helium superconducting surgery system. The guided scan times of the two groups was recorded and compared. In the two groups, the lesion ice coverage in diameter of ≥ 3 cm and < 3 cm were recorded, and freezing effective rate was compared. Hepatic perfusion values [hepatic artery perfusion (HAP), portal vein perfusion (PVP), and the hepatic arterial perfusion index (HAPI)] of tumor tissues, adjacent tissues and normal liver tissues at preoperative and postoperative four weeks in the two groups were compared. Local tumor changes were recorded and efficiency was compared at four weeks post-operation. Adverse events were recorded and compared between the two groups, including fever, pain, frostbite, nausea, vomiting, pleural effusion and abdominal bleeding. RESULTS:Guided scan times in the dual-slice group was longer than that in the 64-slice group (t = 11.445, P = 0.000). The freezing effective rate for tumors < 3 cm in diameter in the dual-slice group (81.58%) was lower than that in the 64-slice group (92.86%) (χ2 = 5.707, P = 0.017). The HAP and HAPI of tumor tissues were lower at four weeks post-treatment than at pre-treatment in both groups (all P < 0.05), and those in the 64-slice group were lower than that in the dual-slice group (all P < 0.05). HAP and PVP were lower and HAPI was higher in tumor adjacent tissues at post-treatment than at pre-treatment (all P < 0.05). Furthermore, the treatment effect and therapeutic efficacy in the dual-slice group were lower than the 64-slice group at four weeks post-treatment (all P < 0.05). Moreover, pleural effusion and intraperitoneal hemorrhage occurred in patients in the dual-slice group, while no complications occurred in the 64-slice group (all P < 0.05). CONCLUSION:64-slice spiral CT applied with cryoablation in targeted therapy for liver cancer can achieve a safe and effective freezing treatment, so it is worth being used.

背景与目标： 目的：观察64层螺旋CT和冷冻消融联合靶向治疗肝癌的效果。
方法：本研究共纳入124例患者（142个肿瘤）。根据使用双层螺旋CT或64层螺旋CT的指导技术，将患者分为两组：双层组（n = 56，65个肿瘤）和64层组（n = 8， 77个肿瘤）。所有患者均接受了氩氦超导手术系统的靶向治疗。记录并比较两组的指导扫描时间。两组均记录直径≥3 cm和<3 cm的病变冰覆盖率，并比较冷冻有效率。比较两组患者术前和术后4周的肿瘤组织，邻近组织和正常肝组织的肝灌注值[肝动脉灌注（HAP），门静脉灌注（PVP）和肝动脉灌注指数（HAPI）]。 。记录局部肿瘤变化，并在术后四周比较效率。记录并比较两组的不良事件，包括发烧，疼痛，冻伤，恶心，呕吐，胸腔积液和腹腔出血。
结果：双切片组的指导扫描时间比64切片组的指导扫描时间更长（t = 11.445，P = 0.000）。双切片组对直径<3 cm的肿瘤的冷冻有效率（81.58％）低于64切片组的冷冻有效率（92.86％）（χ2= 5.707，P = 0.017）。两组在治疗后4周的肿瘤组织HAP和HAPI均低于治疗前（均P <0.05），而64层组的肿瘤组织的HAP和HAPI均低于双层组（均P <0.05）。 P <0.05）。与治疗前相比，治疗后肿瘤邻近组织中的HAP和PVP较低，而HAPI较高（所有P <0.05）。此外，在治疗后4周，双切片组的治疗效果和疗效均低于64切片组（所有P <0.05）。此外，双排组患者发生胸腔积液和腹膜内出血，而64排组患者未发生并发症（所有P <0.05）。
结论：64层螺旋CT联合冷冻消融术在肝癌靶向治疗中可达到安全有效的冷冻治疗，值得推广。

BACKGROUND & AIMS: OBJECTIVES:To evaluate the usability of a neuropsychological screening instrument and two observation scales of everyday behaviour to describe cognitive and functional capacity of patients with multiepisode schizophrenia and considerable care needs, who frequently refuse to participate in cognitive testing or performance-based functional measurement. SETTING:One psychiatric unit specialised in severe mental illness at the Sahlgrenska University Hospital, Gothenburg, Sweden. PARTICIPANTS:Patients were included consecutively from date of admission to the unit. INCLUSION CRITERIA:age 18-65 years, International Classification of Diseases 10 diagnoses F20.0-F20.9 (schizophrenia) or F25.0-F25.9 (schizoaffective disorder) since at least 5 years. EXCLUSION CRITERIA:acute serious psychotic episodes or physical illness, alcohol or drug abuse during the year before the study, diagnosed cerebral disorder at admission to the unit, and insufficient ability to speak Swedish. 64 patients filled the criteria and 19 accepted participation: 14 males, 5 females, median age 56 years. OUTCOME MEASURES:Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS) scores, measured by a psychologist; Frontal Systems Behaviour Scale (FrSBe) Family Version and Functional Independence Measure (FIM) V.4.0 scores, measured by nursing staff. Non-parametric statistics were consistently applied to process the data. RESULTS:Failure analysis showed differences regarding gender and subdiagnoses between participants and non-participants. All participants had BNIS scores indicating cognitive dysfunction. FrSBe group medians showed apathy and executive problems, indicating possible frontal lobe disturbance. FIM showed dependency on others for linguistic and social communication, everyday problem solving, and remembering persons and daily routines. Correlations between FrSBe and FIM (p≤0.01) suggested executive dysfunction being crucial to explain difficulties in performing activities of daily functioning. CONCLUSIONS:Indications of considerable cognitive and functional difficulties found among the participants suggestedthat the instruments are clinically applicable for tentative assessment of cognitive and functional ability among patients with multiepisode schizophrenia and considerable care needs.

背景与目标： 目的：评估神经心理筛查仪器的可用性和两种日常行为观察量表，以描述多发性精神分裂症患者和需要大量护理的患者的认知和功能能力，这些患者经常拒绝参加认知测试或基于性能的功能测量。
地点：瑞典哥德堡萨尔格伦斯卡大学医院的一个专门治疗严重精神疾病的精神病科。
参加者：自入院之日起连续纳入患者。
纳入标准：年龄18-65岁，国际疾病分类10至少从5年开始诊断为F20.0-F20.9（精神分裂症）或F25.0-F25.9（精神分裂症）。
排除标准：在研究前的一年中发生了严重的精神病发作或身体疾病，酗酒或滥用药物，入院时被诊断出脑部疾病以及瑞典语说能力不足。符合标准的64位患者和19位接受研究的患者：男14例，女5例，中位年龄56岁。
观察指标：巴罗神经病学研究所筛查的较高脑功能（BNIS）分数，由心理学家进行测量；额叶系统行为量表（FrSBe）家庭版本和功能独立性量度（FIM）V.4.0分数，由护理人员衡量。非参数统计被一致地应用于处理数据。
结果：故障分析显示，参与者和非参与者之间在性别和亚诊断方面存在差异。所有参与者的BNIS评分均表明认知功能障碍。 FrSBe组中位数显示冷漠和执行问题，表明可能存在额叶紊乱。 FIM在语言和社交沟通，日常问题解决以及对人和日常活动的记忆方面表现出对他人的依赖。 FrSBe与FIM之间的相关性（p≤0.01）表明执行功能障碍对于解释日常工作活动中的困难至关重要。
结论：在参与者中发现的相当多的认知和功能困难的指征表明，该仪器在临床上可用于多发性精神分裂症和相当大的护理需求的患者的认知和功能能力的初步评估。

BACKGROUND & AIMS: PURPOSE:This study aimed to investigate the behavior patterns of typical noise sources in critical care wards and relate their patterns to health care environment in which the sources adapt themselves in several different forms. METHODS:An effective observation approach was designed for noise behavior in the critical care environment. Five descriptors have been identified for the behavior observations, namely, interval, frequency, duration, perceived loudness, and location. Both the single-bed and the multiple-bed wards at the selected Critical Care Department were randomly observed for 3 inconsecutive nights, from 11:30 pm to 7:00 am the following morning. The Matlab distribution fitting tool was applied afterward to plot several types of distributions and estimate the corresponding parameters. RESULTS:The lognormal distribution was considered the most appropriate statistical distribution for noise behaviors in terms of the interval and duration patterns. The turning of patients by staff was closely related to the increasing occurrences of noises. Among the observed noises, talking was identified with the highest frequency, shortest intervals, and the longest durations, followed by monitor alarms. The perceived loudness of talking in the nighttime wards was classified into 3 levels (raised, normal, and low). Most people engaged in verbal communication in the single-bed wards that occurred around the Entrance Zone, whereas talking in the multiple-bed wards was more likely to be situated in the Staff Work Zone. As expected, more occurrences of noises along with longer duration were observed in multiple-bed wards rather than single-bed wards. "Monitor plus ventilator alarms" was the most commonly observed combination of multiple noises.

背景与目标： 目的：本研究旨在调查重症监护病房中典型噪声源的行为模式，并将其模式与卫生保健环境相关联，在该环境中，噪声源以几种不同形式进行适应。
方法：针对重症监护环境中的噪声行为设计了一种有效的观察方法。已经为行为观察确定了五个描述符，即间隔，频率，持续时间，感知的响度和位置。从所选的重症监护室的单床病房和多床病房在晚上11:30 pm至第二天早上7:00连续3个连续晚上。之后使用Matlab分布拟合工具绘制几种类型的分布并估计相应的参数。
结果：就间隔和持续时间模式而言，对数正态分布被认为是最适合噪声行为的统计分布。医务人员的转机与噪声的发生率增加密切相关。在观察到的噪音中，说话被识别为频率最高，间隔最短，持续时间最长，其次是监视器警报。夜间病房中说话的感觉响度分为3级（提高，正常和低）。大多数人在入口区附近的单人病房中进行口头交流，而在多人病房中交谈的人更可能位于员工工作区。正如预期的那样，在多床病房而不是单床病房中观察到了更多的噪音以及持续时间更长。 “监视器加呼吸机警报”是多种噪声中最常见的组合。

BACKGROUND & AIMS: STUDY OBJECTIVE:We determine the effect of the duration of emergency department (ED) observation on computed tomography (CT) rate for children with minor blunt head trauma. METHODS:We performed a prospective cohort study of children with blunt head trauma and a Glasgow Coma Scale score greater than 14. We defined time from injury as the time from head injury to initial physician (emergency attending physician or fellow) assessment. For children who were observed in the ED before CT decisionmaking, we defined ED observation time as time from initial physician assessment to the decision whether to obtain a CT. After adjusting for time from injury, patient age, sex, physician type, and study month, we measured the effect of ED observation time on CT rate in each of the 3 Pediatric Emergency Care Applied Research Network Traumatic Brain Injury risk groups. RESULTS:Of the 1,605 eligible patients, we enrolled 1,381 (86%). Of the enrolled patients, 676 (49%) were observed in the ED and 272 (20%) had a CT performed. After adjustment, every hour of ED observation time was associated with a decrease in CT rate for children in all 3 traumatic brain injury risk groups: high risk (adjusted odds ratio [OR] 0.11; 95% confidence interval [CI] 0.05 to 0.24), intermediate risk (adjusted OR 0.28; 95% CI 0.21 to 0.36), and low risk (adjusted OR 0.47; 95% CI 0.31 to 0.73). All 8 children with a significant traumatic brain injury had an immediate CT. CONCLUSION:For children with minor blunt head trauma, ED observation time was associated with a time-dependent reduction in cranial CT rate, with no delay in the diagnosis of a significant traumatic brain injury.

背景与目标： 目的：我们确定急诊科（ED）观察时间对轻度颅脑外伤儿童的X线计算机断层扫描（CT）率的影响。
方法：我们对钝性头部外伤且格拉斯哥昏迷量表评分大于14的儿童进行了一项前瞻性队列研究。我们将受伤后的时间定义为从头部受伤到最初的医师（急诊医师或同伴）评估的时间。对于在做出CT决策之前在ED中进行观察的儿童，我们将ED观察时间定义为从最初的医师评估到决定是否获得CT的时间。在调整了受伤，患者年龄，性别，医师类型和研究月份的时间后，我们在3个儿科急诊应用研究网络创伤性脑损伤风险组中的每一个中测量了ED观察时间对CT率的影响。
结果：在1,605名合格患者中，我们招募了1,381名（86％）。在入组患者中，在ED中观察到676例（49％），并且进行了CT的272例（20％）。调整后，在所有三个创伤性脑损伤风险组中，儿童每小时的ED观察时间与儿童CT率降低相关：高风险（校正后的优势比[OR] 0.11； 95％置信区间[CI] 0.05至0.24） ，中等风险（调整后的OR为0.28； 95％CI为0.21至0.36）和低风险（调整后的OR为0.47； 95％CI为0.31至0.73）。所有8名患有严重颅脑外伤的儿童均立即进行了CT检查。
结论：对于轻微钝性颅脑外伤的儿童，ED观察时间与颅内CT率的时间依赖性降低有关，而对严重颅脑外伤的诊断没有延迟。

BACKGROUND & AIMS: BACKGROUND:Little research has been conducted to validate pain assessment tools in critical care, especially for patients who cannot communicate verbally. OBJECTIVE:To validate the Critical-Care Pain Observation Tool. METHODS:A total of 105 cardiac surgery patients in the intensive care unit, recruited in a cardiology health center in Quebec, Canada, participated in the study. Following surgery, 33 of the 105 were evaluated while unconscious and intubated and 99 while conscious and intubated; all 105 were evaluated after extubation. For each of the 3 testing periods, patients were evaluated by using the Critical-Care Pain Observation Tool at rest, during a nociceptive procedure (positioning), and 20 minutes after the procedure, for a total of 9 assessments. Each patient's self-report of pain was obtained while the patient was conscious and intubated and after extubation. RESULTS:The reliability and validity of the Critical-Care Pain Observation Tool were acceptable. Interrater reliability was supported by moderate to high weighted kappa coefficients. For criterion validity, significant associations were found between the patients' self-reports of pain and the scores on the Critical-Care Pain Observation Tool. Discriminant validity was supported by higher scores during positioning (a nociceptive procedure) versus at rest. CONCLUSIONS:The Critical-Care Pain Observation Tool showed that no matter their level of consciousness, critically ill adult patients react to a noxious stimulus by expressing different behaviors that may be associated with pain. Therefore, the tool could be used to assess the effect of various measures for the management of pain.

背景与目标： 背景：很少进行研究来验证重症监护中的疼痛评估工具，特别是对于无法通过口头交流的患者。
目的：验证重症患者疼痛观察工具。
方法：在加拿大魁北克市心脏病健康中心招募的重症监护病房中共有105名心脏外科手术患者参加了这项研究。手术后，对105例中有33例进行了无意识和气管插管评估，有99例进行了有意识和气管插管评估。拔管后对所有105例进行评估。对于这三个测试阶段中的每个阶段，均在休息，伤害性手术（定位）期间以及手术后20分钟使用静息疼痛疼痛观察工具对患者进行评估，共进行9次评估。在患者清醒并插管时和拔管后，获得每个患者的自我疼痛报告。
结果：重症监护疼痛观察工具的可靠性和有效性是可以接受的。 Interrater的可靠性由中等到较高的加权Kappa系数提供支持。对于标准有效性，在患者的自我疼痛报告与重症监护疼痛观察工具的评分之间发现显着关联。定位（伤害性操作）与静止时的较高分数可支持判别有效性。
结论：重症监护疼痛观察工具显示，无论危重患者的意识水平如何，重症成年患者都会通过表达可能与疼痛相关的不同行为来对有害刺激做出反应。因此，该工具可用于评估各种疼痛控制措施的效果。

BACKGROUND & AIMS: :Percutaneous transluminal coronary angioplasty (PTCA) with stent implantation is widely used for the treatment of coronary stenosis. However, restenosis after stent implantation frequently reported by intravascular ultrasound evaluation. This may occur because of the reduced luminal area after implantation, insufficient stent expansion, or by the elastic recoil of the stent (ERS). Quantitative evaluation of stent expanding should provide further information on how to decrease the incidence of re-stenosis. Many previous studies have observed stent properties in 2D. However, the stent geometry is changed in 3D space, and 3D measurements will provide further information on factors such as the risk for asymmetric ERS. We performed 3D reconstruction using high spatial resolution images obtained with a Micro-CT system to observe the 3D expansion behavior of a test stent and quantitatively evaluate ERS. The expansion behavior of each structural component of the stent varied, as did the ERS and eccentricity. ERS ranged from 2.4% to 9.2% during observation form proximal and distal positions in each component. The greatest difference in ERS between 2D and 3D measurements was 5.2%. 3D measurements provide more information on ERS than 2D measurements. Our result shows the importance of the observation, and the evaluation by three dimensions.

背景与目标： ：经支架植入的经皮腔内冠状动脉成形术（PTCA）被广泛用于治疗冠状动脉狭窄。但是，支架植入后的再狭窄经常通过血管内超声评估得到报道。这可能是由于植入后的管腔面积减小，支架扩张不足或支架（ERS）的弹性后坐力引起的。支架扩张的定量评估应提供有关如何减少再狭窄发生率的进一步信息。先前的许多研究都观察到了2D支架的特性。但是，支架的几何形状会在3D空间中发生变化，并且3D测量将提供有关诸如不对称ERS风险等因素的更多信息。我们使用Micro-CT系统获得的高空间分辨率图像进行了3D重建，以观察测试支架的3D扩展行为并定量评估ERS。支架的每个结构部件的膨胀行为都不同，ERS和偏心率也不同。在每个组件的近端和远端位置观察时，ERS范围从2.4％到9.2％。 2D和3D测量之间的ERS最大差异为5.2％。 3D测量比2D测量提供更多有关ERS的信息。我们的结果从三个维度显示了观察和评估的重要性。

BACKGROUND & AIMS: OBJECTIVE:To investigate the characteristics of epidemiological distribution of the ossification of the ligamentum flavum (OLF) in the thoracic spine including the incidence, segmental distribution, and shape. METHODS:Chest spiral computed tomography scans of 993 cases (male 506, female 487, mean age 60 years, range 5-102 years) who presented due to chest symptoms were analyzed with axial slices combined with sagittal slices. The conditions of OLF in the thoracic spine, including segments, thickness, location, and dural sac compression, were recorded. Prevalence was standardized according to the "Age Structure of Population in Beijing 2008". RESULTS:Among the population investigated, the standardized prevalence rate was 63.9 %. The standardized prevalence rate for males (68.5 %) was higher than that for females (59.0 %). The highest prevalence rate of OLF was in the 50-59 years age group (79.2 %); however, high density originated it can be found in individuals aged 10-19 years. The comparison of different thoracic segments showed that T10-11 (44.0 %) and T11-12 (41.6 %) had the highest prevalence rates. CONCLUSION:The prevalence of ossification of the ligamentum flavum was highest in the 50-59 years group, but also occurred in early years. OLF occurs more frequently in the lower than in the upper and middle thoracic regions and its prevalence increases with aging.

背景与目标： 目的：探讨胸椎黄韧带骨化症的流行病学分布特征，包括发病率，节段分布和形态。
方法：采用轴向切面结合矢状切面分析了993例因胸部症状而出现的胸部螺旋CT扫描（男506例，女487例，平均年龄60岁，范围5-102岁）。记录胸椎OLF的状况，包括节段，厚度，位置和硬膜囊压缩。流行率根据“北京2008年人口年龄结构”进行了标准化。
结果：在所调查的人群中，标准化患病率为63.9％。男性的标准化患病率（68.5％）高于女性的标准化患病率（59.0％）。 OLF的最高患病率是在50-59岁年龄段（79.2％）；然而，高密度起源于10-19岁的人群。比较不同的胸段，发现T10-11（44.0％）和T11-12（41.6％）的患病率最高。
结论：黄韧带骨化的发生率在50-59岁组中最高，但也发生在早期。 OLF在下部胸部的发生率高于上部和中部胸腔区域，并且其发生率随着年龄的增长而增加。

BACKGROUND & AIMS: OBJECTIVES:Production agriculture is commonly associated with high prevalence of ergonomic injuries, particularly during intensive manual labor and during harvesting. This paper intends to briefly describe an overview of oil palm plantation management highlighting the ergonomics problem each of the breakdown task analysis. METHODS:Although cross-sectional field visits were conducted in the current study, insight into past and present occupational safety and health concerns particularly regarding the ergonomics of oil palm plantations was further exploited. Besides discussion, video recordings were extensively used for ergonomics analysis. RESULTS:The unique commodity of oil palm plantations presents significantly different ergonomics risk factors for fresh fruit bunch (FFB) cutters during different stages of harvesting. Although the ergonomics risk factors remain the same for FFB collectors, the intensity of manual lifting increases significantly with the age of the oil palm trees-weight of FFB. CONCLUSIONS:There is urgent need to establish surveillance in order to determine the current prevalence of ergonomic injuries. Thereafter, ergonomics interventions that are holistic and comprehensive should be conducted and evaluated for their efficacy using approaches that are integrated, participatory and cost-effective.

背景与目标： 目的：生产农业通常与人体工学伤害的高发有关，尤其是在密集的体力劳动和收割期间。本文旨在简要介绍油棕种植园管理概述，重点介绍每个分解任务分析中的人机工程学问题。
方法：尽管在本研究中进行了横断面实地考察，但仍可以深入了解过去和现在的职业安全与健康问题，尤其是关于油棕种植园的人体工学方面。除讨论外，录像还被广泛用于人体工程学分析。
结果：油棕人工林的独特商品在收获的不同阶段对新鲜水果束（FFB）切割机的人体工程学危险因素具有显着不同。尽管FFB收集器的人机工程学风险因素保持不变，但手动举升的强度会随着油棕树的年龄（FFB重量）的增加而显着增加。
结论：迫切需要建立监测手段，以确定当前的人体工学伤害发生率。此后，应采用综合，参与性和成本效益好的方法，进行全面，全面的人体工程学干预措施并评估其有效性。

BACKGROUND & AIMS: :The interaction between T4 DNA and basic polypeptides was observed using fluorescence microscopy. Free DNA molecules exhibited random Brownian motion accompanying the conformational change. With the addition of polycation, such as histone and polyarginine, DNA molecules tended to shrink to become spherical shapes. The persistent lengths and the distributions of long axis lengths of DNA-polyarginine complexes were determined from the video images at various polyarginine concentrations. It is demonstrated that the conformation of DNA changes in a biphasic manner in the presence of polyarginine.

背景与目标： ：使用荧光显微镜观察到T4 DNA和碱性多肽之间的相互作用。游离DNA分子随构象变化表现出随机的布朗运动。随着组蛋白和聚精氨酸等聚阳离子的加入，DNA分子趋于收缩成球形。 DNA-聚精氨酸复合物的持久长度和长轴长度的分布是从视频中不同聚精氨酸浓度确定的。证明在聚精氨酸存在下DNA的构象以双相方式改变。

BACKGROUND & AIMS: SUMMARY:In analysis of longitudinal data, it is often assumed that observation times are predetermined and are the same across study subjects. Such an assumption, however, is often violated in practice. As a result, the observation times may be highly irregular. It is well known that if the sampling scheme is correlated with the outcome values, the usual statistical analysis may yield bias. In this article, we propose joint modeling and analysis of longitudinal data with possibly informative observation times via latent variables. A two-step estimation procedure is developed for parameter estimation. We show that the resulting estimators are consistent and asymptotically normal, and that the asymptotic variance can be consistently estimated using the bootstrap method. Simulation studies and a real data analysis demonstrate that our method performs well with realistic sample sizes and is appropriate for practical use.

背景与目标： 摘要：在纵向数据分析中，通常假设观察时间是预先确定的，并且在研究对象之间是相同的。然而，这种假设在实践中经常被违反。结果，观察时间可能非常不规则。众所周知，如果采样方案与结果值相关，则通常的统计分析可能会产生偏差。在本文中，我们建议通过潜在变量对纵向数据进行联合建模和分析，并可能提供有益的观察时间。开发了两步估计程序来进行参数估计。我们证明了所得的估计量是一致且渐近正态的，并且可以使用bootstrap方法一致地估计渐近方差。仿真研究和实际数据分析表明，我们的方法在实际样本量下性能良好，适合实际使用。

BACKGROUND & AIMS: :A retrospective review of 373 adult patients admitted to Harbor General Hospital between 1980 and 1984 for minor closed head injury (Glasgow coma scale 13-15) was performed to determine the benefits of skull radiography, computed tomographic (CT) scanning of the head, and admission for observation. Variables reviewed were mental status, neurological examination, presence or absence of loss of consciousness, clinical evidence of basilar skull fracture, and fracture on skull radiography. The neurological examination (including mental status and Glasgow coma scale) in the emergency room was the best predictor of subsequent deterioration or the presence of an operative hematoma. The only patients with Glasgow coma scale scores of 15 who required surgical evacuation of an extraaxial hematoma had focal neurological deficits referable to hemispheric compression, with or without an abnormal mental status. A Glasgow coma scale score of 13 or 14 places the patient at risk either of having a hematoma requiring surgery or of deteriorating. We recommend that a head CT scan be obtained on all patients with Glasgow coma scale scores of less than 15, abnormal mental status, or hemispheric neurological deficits. If no operative lesion is found on the CT scan, the patient should be admitted for observation because there is still a risk of deterioration. Those with a Glasgow coma scale score of 15, a normal mental status, and no hemispheric neurological deficit may be discharged to be observed at home by a competent observer despite basilar or calvarial skull fracture, loss of consciousness, or cranial nerve deficit. No benefit was gained from skull radiography in any group.

背景与目标： ：回顾性研究了1980年至1984年之间因轻微闭合性颅脑损伤（格拉斯哥昏迷评分为13-15）而在港口总医院住院的373名成年患者，以确定颅骨X线摄影，头部CT扫描的益处，和入场观察。所审查的变量包括精神状态，神经系统检查，是否存在意识丧失，基底颅骨骨折的临床证据以及颅骨X线片骨折。急诊室的神经系统检查（包括精神状态和格拉斯哥昏迷评分）是随后恶化或存在手术性血肿的最佳预测指标。仅有的需要格拉斯哥昏迷量表评分为15且需要手术清除轴外血肿的患者具有局灶性神经功能缺损，相当于半球压迫，无论是否患有异常的精神状态。格拉斯哥昏迷量表评分为13或14，使患者处于需要手术的血肿或恶化的危险中。我们建议对所有格拉斯哥昏迷评分低于15，精神状态异常或半球神经功能缺损的患者进行头部CT扫描。如果在CT扫描中未发现手术病变，则应允许患者进行观察，因为仍然存在恶化的风险。格拉斯哥昏迷评分为15，精神状态正常，半球神经功能缺损的人，即使基底或颅骨颅骨骨折，意识丧失或颅神经缺损，也可以由合格的观察者在家中观察到。在任何组中，颅骨放射照相均未获得任何益处。

BACKGROUND & AIMS: BACKGROUND:Infantile hemangioma (IH) can lead to severe complications. The 595-nm pulsed dye laser is poorly effective on thick and deep IH. Long-pulsed alexandrite laser has the proper wavelength of 755 nm and a relatively deep penetration. Thus, this may be a safe and effective treatment method for relatively deep or thick IH. AIMS AND OBJECTIVES:This study aims to determine whether 595-nm pulsed dye laser and 755-nm long-pulsed alexandrite laser in sequential therapy are safer and more effective for relatively deep or thick hemangioma. MATERIALS AND METHODS:This was a prospective study. A total of 194 infantile IH patients (thickness greater than 2 mm and less than 8 mm) were randomly divided into two groups: control group (treated using 595-nm pulsed dye laser) and experimental group (treated by sequential therapy with 755-nm long-pulsed alexandrite laser and 595-nm dye laser). RESULTS:The control group had a total effective rate of 36.1%, while the experimental group had a total effective rate of 76.3%. Enumeration data were compared by X2 -test. The results were considered statistically significant at P < .05. CONCLUSION:Sequential therapy with 755-nm pulsed dye laser and 595-nm long-pulsed alexandrite laser is a safe and effective treatment approach for relatively deep or thick hemangioma.

背景与目标： 背景：小儿血管瘤（IH）可导致严重的并发症。 595 nm脉冲染料激光对厚和深IH效果不佳。长脉冲变石激光器具有适当的755 nm波长和相对较深的穿透力。因此，对于相对较深或较厚的IH，这可能是一种安全有效的治疗方法。
目的和目的：本研究旨在确定序贯治疗中的595 nm脉冲染料激光和755 nm长脉冲变石激光对于相对较深或较厚的血管瘤是否更安全，更有效。
材料与方法：这是一项前瞻性研究。总共194名婴儿IH患者（厚度大于2 mm且小于8 mm）被随机分为两组：对照组（使用595 nm脉冲染料激光治疗）和实验组（通过755 nm顺序治疗）长脉冲变石激光器和595 nm染料激光器）。
结果：对照组总有效率36.1％，实验组有76.3％。通过X2-检验比较枚举数据。结果被认为在P <.05上具有统计学意义。
结论：采用755nm脉冲染料激光和595nm长脉冲变石激光进行序贯治疗是治疗较深或较厚血管瘤的一种安全有效的方法。

BACKGROUND & AIMS: Purpose:To evaluate the change of retinal thickness and ocular microvasculature in a rat model of retinitis pigmentosa using swept source optical coherence tomography angiography (SS-OCTA). Methods:Three-weeks-old Royal College of Surgeons (RCS) rats (n = 8) and age-matched control rats (n = 14) were imaged by a prototype SS-OCTA system. Follow-up measurements occurred every three weeks on six RCS rats until week 18, and cross-sectional measurements were conducted on control rats. Thicknesses of different retinal layers and the total retina were measured. The enface angiograms from superficial vascular plexiform (SVP) and deep capillary plexiform (DCP) were analyzed, and the image sharpness was also extracted from the choroidal angiograms. Immunohistochemical analysis was done in the RCS rats after week 18, as well as in three-week-old RCS rats and age-matched controls. Results:In RCS rats, the thicknesses of the ganglion cell complex, the nuclear layer, the debris/photoreceptor layer and the total retina decreased over the weeks (P < 0.001). The SVP metrics remained unchanged whereas the DCP metrics decreased significantly over the weeks (P < 0.001). The immunohistochemical analysis confirmed our OCTA findings of capillary dropout in the DCP. The choroidal plexus appeared indistinct initially due to scattering of light at the intact retinal pigment epithelium (RPE) and became more visible after week nine probably due to RPE degeneration. Loss of choriocapillaris was visualized at week 18. In control rats, no vascular change was detected, but nuclear layers, photoreceptor layers and total retina showed slight thinning with age (P < 0.001). Conclusions:Photoreceptor degeneration in RCS rats was associated with the loss of capillaries in DCP, but not in SVP. The OCTA imaging allows for the characterization of structural and angiographic changes in rodent models.

背景与目标： 目的：使用扫频光源光学相干断层扫描血管造影（SS-OCTA）评估色素性视网膜炎大鼠模型中视网膜厚度和眼微血管的变化。
方法：使用原型SS-OCTA系统对三周大的皇家外科医学院（RCS）大鼠（n = 8）和年龄匹配的对照大鼠（n = 14）进行成像。在六只RCS大鼠上每三周进行一次随访测量，直到第18周为止，并在对照组大鼠上进行横断面测量。测量不同视网膜层和整个视网膜的厚度。分析了浅表血管丛状（SVP）和深层毛细管丛状（DCP）的面血管造影，并从脉络膜血管造影中提取图像清晰度。在第18周后在RCS大鼠中以及三周大的RCS大鼠和年龄匹配的对照组中进行了免疫组织化学分析。
结果：在RCS大鼠中，神经节细胞复合物，核层，碎片/感光层和总视网膜的厚度在几周内下降（P <0.001）。 SVP指标保持不变，而DCP指标在过去几周中显着下降（P <0.001）。免疫组织化学分析证实了我们在DCP中OCTA的毛细血管脱落现象。脉络丛起初由于在完整的视网膜色素上皮（RPE）处散射而显得模糊，在第9周后可能由于RPE变性而变得更加明显。在第18周观察到脉络膜毛细血管的丧失。在对照组中，未检测到血管变化，但是核层，感光层和整个视网膜随年龄增长而略微变薄（P <0.001）。
结论：RCS大鼠的光感受器变性与DCP中毛细血管的丢失有关，而与SVP中的毛细血管丢失无关。 OCTA成像可表征啮齿动物模型中的结构和血管造影变化。