BACKGROUND & AIMS: OBJECTIVE:To identify reasons why rural general practitioners (GPs) treat a large proportion of patients with a primary psychiatric diagnosis in general beds of their local hospitals, and the barriers encountered when providing this treatment. DESIGN:A postal questionnaire was developed and distributed to a sample of rural GPs, asking about the treatment of patients with an acute mental illness in their local hospital. RESULTS:The majority of GPs agreed that they treat the acutely mentally ill in general beds of their local hospital due to lack of availability of, and inability to gain access to, mental health beds in the larger centres; and also to enable ongoing family involvement and continuity of care. Distance factors were identified as least significant. Barriers to providing care to this group of patients included a perceived lack of support by consultant psychiatrists, confidentiality issues, lack of community mental health workers to provide assistance, aggression levels of patients, inappropriate local hospital setting, and lack of confidence of GPs and general hospital nursing staff. CONCLUSION:Addressing these barriers is necessary if rural Australians are to receive a quality of care that is equal to that received by those located in metropolitan Australia. Continuing research in this area is crucial.

背景与目标： 目的：查明农村全科医生（GPs）在其当地医院的普通病床中治疗大部分患有原发性精神病诊断的患者的原因，以及提供这种治疗时遇到的障碍。
设计：开发了一份邮政调查表，并将其分发给农村全科医生的样本，询问在当地医院治疗患有急性精神疾病的患者的情况。
结果：大多数全科医生都同意，由于在较大的中心缺乏精神病床，并且无法获得精神病床，他们在当地医院的普通病床中治疗严重的精神疾病；并使家庭不断参与并获得连续护理。距离因素被确定为最不重要的。向此类患者提供护理的障碍包括：咨询精神病医生缺乏支持，机密性问题，缺乏社区精神卫生工作者提供援助，患者的攻击性，当地医院的环境不适当以及全科医生和普通医生的信心不足医院护理人员。
结论：如果要使澳大利亚农村人口获得与澳大利亚大都市居民相同的医疗质量，则必须解决这些障碍。在这一领域的持续研究至关重要。

BACKGROUND & AIMS: :Before the 2017 election of the Director-General of WHO, and given the importance of human rights to global health governance through WHO, Health and Human Rights asked the three final candidates for their views on human rights, WHO's human rights mandate, and the role of human rights in WHO programming. These questions were developed by the author in collaboration with Audrey Chapman, Lisa Forman, Paul Hunt, Dainius Pūras, Javier Vasquez and Carmel Williams. Based on responses to these questions from each of the three candidates, this Perspective was originally published online on April 26, 2017. On May 23, 2017, Dr Tedros Adhanom Ghebreyesus was elected Director-General and will begin his five-year term on July 1, 2017.

背景与目标： ：在2017年世界卫生组织总干事选举之前，并考虑到人权对通过世界卫生组织进行全球卫生治理的重要性，卫生与人权要求三位最终候选人对人权，世卫组织的人权任务和对人权的看法。人权在世卫组织规划中的作用。这些问题是由作者与Audrey Chapman，Lisa Forman，Paul Hunt，DainiusPūras，Javier Vasquez和Carmel Williams合作开发的。根据从各三名候选人的回答这些问题，这种观点最初是在线发表于2017年4月26日，2017年5月23日，Tedros Adhanom Ghebreyesus博士当选总干事，并将于七月他的五年任期2017年1月1日。

BACKGROUND & AIMS: :Genetic factors are important for developing primary and subsequent malignancies in children. This study investigated the role of genetic factors involved in DNA-repair. Designed as a feasibility study, it addressed the possibility of obtaining samples for genetic analyses from former patients through the German Childhood Cancer Registry. Testing feasibility was as important as the biological question itself. We analyzed the expression of DNA-repair genes in untreated primary fibroblasts of 20 individuals with a second neoplasm compared to 20 matched single neoplasm cases using customized cDNA microarrays (1344 gene sequences, about 800 genes). Matching was by first neoplasm, age, and year of first diagnosis. Forty-six percent of the 52 contacted second neoplasm cases and 18% of the 132 single neoplasm patients participated in the study. The DNA-repair gene results show small differences in the basal gene expression of FTH1 and CDKN1A. To our knowledge, this is the first study using gene expression arrays in untreated primary fibroblasts regarding second neoplasms after a childhood neoplasm. We were able to recruit childhood cancer patients for genetic analyses long after diagnosis. The biological importance of the differences in the DNA-repair gene expression has to be elucidated yet.

背景与目标： ：遗传因素对于发展儿童原发性和随后的恶性肿瘤很重要。这项研究调查了遗传因素在DNA修复中的作用。作为一项可行性研究而设计，它解决了通过德国儿童癌症登记处从以前的患者那里获得用于基因分析的样本的可能性。测试的可行性与生物学问题本身一样重要。我们使用定制的cDNA微阵列（1344个基因序列，约800个基因）分析了20个具有第二个肿瘤的个体的未治疗原代成纤维细胞中的DNA修复基因的表达，与之比较的是20个匹配的单个肿瘤病例。匹配的依据是首次肿瘤，年龄和首次诊断的年份。在52例接触的第二肿瘤病例中，有46％参与了研究，在132例单发肿瘤患者中，有18％参与了研究。 DNA修复基因结果显示FTH1和CDKN1A的基础基因表达有微小差异。就我们所知，这是第一项在未治疗的原代成纤维细胞中使用基因表达阵列的研究，涉及童年肿瘤之后的第二次肿瘤。诊断后很长一段时间，我们就能够招募儿童期癌症患者进行基因分析。 DNA修复基因表达差异的生物学重要性尚未阐明。

BACKGROUND & AIMS: :Active surveillance and diagnosis of the influenza pandemic (H1N1) 2009 (pH1N1) have played a critical role in the effective control and prevention of the pandemic in China. Although several commercially available real-time PCR kits for pH1N1 virus have been used in diagnostic laboratories in Beijing, little has been known about the performance of these kits for detecting pH1N1 virus. In this study, the performance of two commercial real-time PCR kits in Beijing was evaluated. Analysis of clinical samples showed that the positive detection rate for the AgPath-ID™ kit (38.2%) was significantly higher than that for the Da An H1N1 kit (30.0%) (McNemar's chi-square test, P=0.000). The limit of detection (LOD) of the AgPath-ID™ kit was 10(2), 10(2), and 10(3) copies/reaction for the Influenza A (set 1), H1N1 Influenza A (set 2) and H1N1 Influenza A Sub H1 (set 3) genes, respectively, whereas the LOD of the Da An kit was 10(3) copies/reaction for both H1 and N1 genes. Although the AgPath-ID™ kit exhibited a significantly higher detection rate for pH1N1 than the Da An kit, cross-reactivity to A/PR8/34 was found for the AgPath-ID™ kit for H1N1 Influenza A (set 2).

背景与目标： ：积极监测和诊断2009年H1N1流感大流行（pH1N1）在有效控制和预防中国大流行中发挥了关键作用。尽管北京的诊断实验室已经使用了几种针对pH1N1病毒的实时PCR试剂盒，但对于这些试剂盒检测pH1N1病毒的性能知之甚少。在这项研究中，评估了北京两种商业实时PCR试剂盒的性能。临床样品分析表明，AgPath-ID™试剂盒的阳性检出率（38.2％）大大高于大安H1N1试剂盒的检出率（30.0％）（McNemar卡方检验，P = 0.000）。对于甲型流感（第1组），甲型H1N1流感（第2组）和甲型流感（组1），AgPath-ID™试剂盒的检测限（LOD）为10（2），10（2）和10（3）拷贝/反应。 H1N1甲型流感亚H1（第3组）基因，而大安试剂盒的LOD对H1和N1基因均为10（3）拷贝/反应。尽管AgPath-ID™试剂盒对pH1N1的检测率比Da An试剂盒高得多，但发现针对H1N1甲型流感的AgPath-ID™试剂盒（组2）与A / PR8 / 34有交叉反应。

BACKGROUND & AIMS: :Hemorrhage is the most preventable cause of posttraumatic death. Many cases are potentially anatomically salvageable, yet remain lethal without logistics or trained personnel to deliver diagnosis or resuscitative surgery in austere environments. Revolutions in technology for remote mentoring of ultrasound and surgery may enhance capabilities to utilize the skill sets of non-physicians. Thus, our research collaborative explored remote mentoring to empower non-physicians to address junctional and torso hemorrhage control in austere environments. Major studies involved using remote-telementored ultrasound (RTMUS) to identify torso and junctional exsanguination, remotely mentoring resuscitative surgery for torso hemorrhage control, understanding and mitigating physiological stress during such tasks, and the technical practicalities of conducting damage control surgery (DCS) in austere environments. Iterative projects involved randomized guiding of firefighters to identify torso (RCT) and junctional (pilot) hemorrhage using RTMUS, randomized remote mentoring of MedTechs conducting resuscitative surgery for torso exsanguination in an anatomically realistic surgical trainer ("Cut Suit") including physiological monitoring, and trained surgeons conducting a comparative randomized study for torso hemorrhage control in normal (1g) versus weightlessness (0g). This work demonstrated that firefighters could be remotely mentored to perform just-in-time torso RTMUS on a simulator. Both firefighters and mentors were confident in their abilities, the ultrasounds being 97% accurate. An ultrasound-naive firefighter in Memphis could also be remotely mentored from Hawaii to identify and subsequently tamponade an arterial junctional hemorrhage using RTMUS in a live tissue model. Thereafter, both mentored and unmentored MedTechs and trained surgeons completed resuscitative surgery for hemorrhage control on the Cut-Suit, demonstrating practicality for all involved. While remote mentoring did not decrease blood loss among MedTechs, it increased procedural confidence and decreased physiologic stress. Therefore, remote mentoring may increase the feasibility of non-physicians conducting a psychologically daunting task. Finally, DCS in weightlessness was feasible without fundamental differences from 1g. Overall, the collective evidence suggests that remote mentoring supports diagnosis, noninvasive therapy, and ultimately resuscitative surgery to potentially rescue those exsanguinating in austere environments and should be more rigorously studied.

背景与目标： ：出血是创伤后死亡的最可预防原因。许多病例在解剖学上可能是可挽救的，但如果没有后勤人员或训练有素的人员在严酷的环境中进行诊断或复苏手术，则仍然致命。超声和手术的远程指导技术的革命可能会增强利用非医师技能的能力。因此，我们的研究合作探索了远程指导，以使非医师能够在严峻的环境中解决交界处和躯干出血的控制问题。重大研究涉及使用远程元素超声（RTMUS）识别躯干和关节血流失血，远程指导复苏手术以控制躯干出血，了解和缓解此类任务期间的生理压力以及在严格的条件下进行损伤控制手术（DCS）的技术实用性环境。迭代项目涉及使用RTMUS随机指导消防员以识别躯干（RCT）和交界处（飞行员）出血，在解剖学上现实的外科培训师（Cut Suit）中进行进行复苏性躯干放血手术的MedTechs的随机远程指导，包括生理监测，以及训练有素的外科医生，对正常（1g）和失重（0g）的躯体出血控制进行比较随机研究。这项工作表明，可以远程指导消防员在模拟器上执行即时躯干RTMUS。消防员和指导者都对自己的能力充满信心，超声波准确率达97％。孟菲斯市的一名初次使用超声的消防员也可以从夏威夷进行远程指导，以在活组织模型中使用RTMUS识别并随后压塞动脉结膜出血。此后，受指导和未受指导的MedTechs以及受过训练的外科医生都完成了复苏手术，以控制Cut-Suit上的出血，证明了所有参与者的实用性。尽管远程指导并没有减少MedTechs的失血量，但它增加了程序的置信度并降低了生理压力。因此，远程指导可能会增加非医师执行心理艰巨任务的可行性。最终，失重的DCS是可行的，与1g的差异不大。总体而言，集体证据表明，远程指导支持诊断，无创治疗以及最终的复苏手术，以挽救那些在严酷环境中放血的人，因此应进行更严格的研究。

BACKGROUND & AIMS: :Previous studies have shown that drugs which block the reuptake of catecholamine neurotransmitters improve impulse control in diseases such as attention deficit hyperactivity disorder (ADHD). Serotonin-specific reuptake inhibitors (SSRI) lack efficacy in ADHD and have been linked to increased suicide risk. The present study investigated drugs with affinity for one or more of the monoamine reuptake transporters using the 5-choice serial reaction time task, a model of attention and impulsivity in rodents. We also tested the effects of the alpha(2)-adreoceptor antagonist, idazoxan and novel antidepressant, agomelatine, which both increase cortical noradrenaline concentrations through non-reuptake mechanisms. Improvements in impulse control were observed with venlafaxine, a serotonin and noradrenaline re-uptake inhibitor (SNRI) but not bupropion (dopamine and noradrenaline re-uptake inhibitor). Sibutramine (SNRI) reduced premature responses by ~50% at the highest dose tested but this was not significant. All three of the SSRIs tested reduced premature responding in a dose-dependent manner, although also slowed response and collection latencies. Neither idazoxan nor agomelatine significantly reduced premature responding, suggesting a lack of efficacy at the doses tested. None of the drugs tested improved attention in this task but sibutramine (SNRI), fluoxetine (SSRI) and paroxetine (SSRI) all increased omissions at the highest dose tested. These data suggest that the SNRIs and SSRIs reduce premature responding but tend to be less specific than noradrenaline specific reuptake inhibitors in this model. SSRIs did not induce any specific impairment in impulse control in this model.

背景与目标： ：以前的研究表明，阻断儿茶酚胺神经递质再摄取的药物可改善注意力缺陷多动障碍（ADHD）等疾病的冲动控制。血清素特异性再摄取抑制剂（SSRI）在ADHD中缺乏疗效，并且与自杀风险增加有关。本研究使用5-choice系列反应时间任务（一种在啮齿动物中引起注意和冲动的模型）对一种或多种单胺再摄取转运蛋白具有亲和力的药物进行了研究。我们还测试了α（2）-肾上腺素受体拮抗剂伊达唑烷和新型抗抑郁药阿戈美拉汀的作用，它们均通过非再摄取机制增加了皮质去甲肾上腺素的浓度。使用文拉法辛，一种5-羟色胺和去甲肾上腺素再摄取抑制剂（SNRI）观察到冲动控制有所改善，但未使用安非他酮（多巴胺和去甲肾上腺素再摄取抑制剂）。西布曲明（SNRI）在测试的最高剂量下可将早反应降低〜50％，但这并不明显。测试的所有三个SSRI均以剂量依赖的方式降低了过早的反应，尽管也减慢了反应和收集潜伏期。咪唑x吨和阿戈美拉汀均未显着降低过早反应，表明在所测试的剂量下缺乏疗效。在最高测试剂量下，没有一种被测试的药物能提高注意力，但西布曲明（SNRI），氟西汀（SSRI）和帕罗西汀（SSRI）都会增加遗漏。这些数据表明，在该模型中，SNRI和SSRI降低了过早反应，但特异性低于去甲肾上腺素特异性再摄取抑制剂。在该模型中，SSRI并未在冲动控制中引起任何特定的损害。

BACKGROUND & AIMS: AIMS:To assess the relationship between ambulance attendances, emergency department (ED) presentations and hospital admissions for acute alcohol intoxication and the timing of public holidays, sporting and social events. DESIGN:Time-series analysis was used to explore trends in intoxication in the context of major events. SETTING:Population of Melbourne, Victoria, Australia between 2000 and 2009. PARTICIPANTS:All patients attended by ambulance, presenting to hospital EDs, or admitted to hospital who were classified as acutely alcohol intoxicated. MEASUREMENT:Analysis of daily numbers of presentations for acute alcohol intoxication associated with major events were undertaken, including lead and lag effects. Analyses controlled for day of week and month of year to address temporal and seasonal variations. FINDINGS:Alcohol intoxication presentations were significantly elevated the day before all public holidays, with intoxication cases on the day of public holidays only higher on New Year's Day (ambulance 6.57, 95% confidence intervals (CI): 3.4-9.74; ED 3.34, 95% CI: 1.28-5.4) and ANZAC Day (ambulance 3.71, 95% CI: 0.68-6.75). The Australian Football League (AFL) Grand Final (ED 2.37, 95% CI: 0.55-4.19), Commonwealth Games (ED 2.45, 95% CI: 0.6-4.3) and Melbourne Cup Day (ambulance 6.14, 95% CI: 2.42-9.85) represented the sporting events with significant elevations in acute intoxication requiring medical attention. The last working day before Christmas was the only social event where a significant increase in acute intoxication occurred (ambulance 8.98, 95% CI: 6.8-11.15). CONCLUSIONS:Acute alcohol intoxication cases requiring ambulance, emergency department and hospital in-patient treatment increase substantially on the day preceding public holidays and other major social events.

背景与目标： 目的：评估急救酒精中毒的救护车出勤率，急诊科演示和医院住院之间的关系以及公共假日，体育和社交活动的时间。
设计：时间序列分析用于探讨重大事件中的中毒趋势。
地点：2000年至2009年之间，澳大利亚维多利亚州墨尔本市。
参加者：所有被急救，就诊急诊室急诊就诊或入院的患者均被分类为急性酒精中毒。
测量：进行与主要事件相关的急性酒精中毒的每日呈报次数分析，包括铅和滞后效应。在一周中的某天和一年中的某月进行受控分析，以解决时间和季节变化。
结果：在所有公共假日前一天，酒精中毒的症状明显增加，在公共假日的酒精中毒病例仅在元旦更高（救护车6.57，95％置信区间（CI）：3.4-9.74; ED 3.34，95 ％CI：1.28-5.4）和ANZAC Day（救护车3.71，95％CI：0.68-6.75）。澳大利亚足球联赛（AFL）总决赛（ED 2.37，95％CI：0.55-4.19），英联邦运动会（ED 2.45，95％CI：0.6-4.3）和墨尔本杯日（救护车6.14，95％CI：2.42-） 9.85）代表体育赛事，急性中毒水平明显升高，需要医疗护理。圣诞节前的最后一个工作日是唯一发生急性中毒显着增加的社交活动（救护车8.98，95％CI：6.8-11.15）。
结论：在公共假期和其他重大社会事件发生的前一天，需要救护车，急诊科和医院住院治疗的急性酒精中毒病例大量增加。

BACKGROUND & AIMS: BACKGROUND:There is conflicting evidence as to whether achievement of cholesterol targets at the population level is dependent on the choice and cost of statin. AIM:To investigate the practice-level relationship between cholesterol quality indicators in patients with heart disease, stroke, and diabetes and prescribing of low-cost statins. DESIGN AND SETTING:Correlations and linear regression modelling of retrospective cross-sectional practice-level data with potential explanatory variables in 7909 (96.4%) general practices in England in 2008-2009. METHOD:Quality indicator data were obtained from the Information Centre and prescribing data from the NHS Business Authority. A 'cholesterol quality indicator' score was constructed by dividing the numbers of patients achieving the target for cholesterol control of ≤5 mmol/l in stroke, diabetes, and heart disease by the numbers on each register. A 'low-cost statin' ratio score was constructed by dividing the numbers of defined daily doses of simvastatin and pravastatin by the total numbers of defined daily doses of statins. RESULTS:Simvastatin accounted for 83.3% (standard deviation [SD] = 15.7%) of low-cost statins prescribed and atorvastatin accounted for 85.7% (SD = 14.8%) of high-cost statins prescribed. The mean cholesterol score was 73.7% (SD = 6.0%). Practices using a higher proportion of the low-cost statins were less successful in achieving cholesterol targets. An increase of 10% in the prescribing of low-cost statins was associated with a decrease of 0.46% in the cholesterol quality indicator score (95% confidence interval = -0.54% to -0.38%, P<0.001). CONCLUSION:Greater use of low-cost statins was associated with a small reduction in cholesterol control.

背景与目标： 背景：关于在人群水平上实现胆固醇目标是否取决于他汀类药物的选择和成本，有相互矛盾的证据。
目的：探讨心脏病，中风和糖尿病患者的胆固醇质量指标与廉价他汀类药物处方之间的实践水平关系。
设计与设置：回顾性横截面实践水平数据的相关性和线性回归模型，该数据具有2008年至2009年英格兰7909例（96.4％）常规实践中的潜在解释变量。
方法：质量指标数据是从信息中心获得的，处方数据是从NHS商业管理局获得的。通过将中风，糖尿病和心脏病中达到胆固醇控制目标≤5mmol / l的患者人数除以每个登记册上的人数，来构建“胆固醇质量指标”评分。通过将辛伐他汀和普伐他汀的每日定义剂量数除以他汀类药物的每日定义总数，可以构建“低成本他汀类药物”比率评分。
结果：辛伐他汀占处方中低成本他汀类药物的83.3％（标准偏差[SD] = 15.7％），阿托伐他汀占处方中低成本他汀类药物的85.7％（SD = 14.8％）。平均胆固醇得分为73.7％（SD = 6.0％）。使用较高比例的低成本他汀类药物的做法在实现胆固醇目标方面不太成功。低成本他汀类药物处方的增加10％与胆固醇质量指标得分的0.46％的降低相关（95％置信区间= -0.54％至-0.38％，P <0.001）。
结论：大量使用低成本他汀类药物与降低胆固醇控制量有关。