BACKGROUND & AIMS: This paper presents and discusses selected findings from a study of health-seeking strategies in relation to sexual health among a group of female sex workers in Calcutta, India. Background information on sex work and sexually transmitted disease in Calcutta is followed by the presentation of findings pertaining to women's understandings of (sexual) health, treatment-seeking and service utilisation. In the urban context where health services are readily available, patterns of initial treatment-seeking are shown to be generally (biomedically) appropriate, but subsequent "non-compliant" therapeutic practices give cause for concern. Conventional approaches to the study of "health-seeking behaviour" are reviewed in the light of these findings and questions raised about the appropriateness of approaches that focus on initial choice of treatment type and/or assume processes of health-seeking to be determined primarily by cultural "beliefs" about illness. Inherent biomedical and culturalist biases in the orientation of such research are shown to produce an analytic neglect of the dual influences of material life conditions and people's perceptions of health, rather than illness, upon health-related strategies. Recommendations are made for operational research and policy formulation on the provision of effective sexual health services, and implications are drawn for the scope of interventions and applied research directed at improving sexual health.

背景与目标： 本文介绍并讨论了印度加尔各答一群女性性工作者中与性健康相关的健康寻求策略研究中的部分发现。在加尔各答关于性工作和性传播疾病的背景信息之后，介绍与妇女对（性）健康，寻求治疗和利用服务的认识有关的发现。在容易获得卫生服务的城市环境中，最初寻求治疗的模式已被证明通常（生物医学上）是适当的，但是随后的“不依从”治疗方法引起了人们的关注。鉴于这些发现，对常规的“寻求健康行为”研究方法进行了回顾，并提出了一些有关方法的适当性的问题，这些方法着重于治疗类型的初始选择和/或假设寻求健康的过程主要由以下因素决定：关于疾病的文化“信仰”。研究方向上固有的生物医学和文化主义偏见表明，人们忽视了物质生活条件和人们对健康而不是疾病的看法对健康相关策略的双重影响。为提供有效的性健康服务的运营研究和政策制定提出了建议，并对旨在改善性健康的干预措施和应用研究的范围产生了影响。

BACKGROUND & AIMS: :Cognitive and learning styles research is limited by the lack of evidence supporting valid interpretations of style assessment scores. We sought evidence to support the validity of scores from 4 instruments: the Index of Learning Styles (ILS); the Learning Style Inventory (LSI); the Cognitive Styles Analysis (CSA), and the Learning Style Type Indicator (LSTI). The ILS assesses 4 domains: sensing-intuitive (SensInt), active-reflective (ActRefl), sequential-global (SeqGlob) and visual-verbal (VisVerb), each of which parallel a similar domain in at least 1 of the other instruments. We administered the ILS, LSI and CSA to family medicine and internal medicine residents and Year 1 and 3 medical students and applied the multitrait-multimethod matrix to evaluate convergence and discrimination. After 3 months participants repeated the ILS and completed the LSTI. A total of 89 residents and medical students participated. Multitrait-multimethod analysis showed evidence of both convergence and discrimination for ActRefl (ILS, LSI and LSTI) and SensInt (ILS and LSTI) scores. ILS SeqGlob and SensInt scores showed unanticipated correlation. No other domains met the criteria for convergence or discrimination. Test-retest reliabilities for ILS scores were 0.856 for SensInt, 0.809 for ActRefl, 0.703 for SeqGlob and 0.684 for VisVerb. Cronbach's alpha values were > or = 0.810 for LSI and 0.237-0.758 for LSTI. At least 9 participants misinterpreted the LSI instructions. These data support the validity of ILS active-reflective and sensing-intuitive scores, LSI active-reflective scores and LSTI sensing-intuitive scores for determining learning styles in this population. Cognitive style and learning style scores may not be interchangeable, even for constructs with similar definitions.

背景与目标： ：认知和学习风格研究受到缺乏支持风格评估分数有效解释的证据的限制。我们从4种工具中寻求证据来支持分数的有效性：学习风格指数（ILS），学习风格指数（ILS），学习风格指数（ILS）。学习风格量表（LSI）；认知风格分析（CSA）和学习风格类型指标（LSTI）。 ILS评估了4个域：感知直觉（SensInt），主动反射（ActRefl），顺序全局（SeqGlob）和视觉-言语（VisVerb），它们在至少其他一种仪器中与相似域平行。我们对家庭医学和内科医学居民以及一年级和三年级医学生进行了ILS，LSI和CSA的管理，并应用了多特征-多方法矩阵来评估收敛性和歧视性。 3个月后，参与者重复ILS并完成了LSTI。共有89名居民和医科学生参加。多特征多方法分析显示ActRefl（ILS，LSI和LSTI）和SensInt（ILS和LSTI）得分具有收敛性和歧视性的证据。 ILS SeqGlob和SensInt评分显示出乎意料的相关性。没有其他领域符合融合或歧视的标准。 ILS分数的重测信度是SensInt为0.856，ActRefl为0.809，SeqGlob为0.703和VisVerb为0.684。 LSI的Cronbachα值>或= 0.810，LSTI的Cronbachα值> 0.237-0.758。至少有9位与会人员误解了LSI的说明。这些数据支持ILS主动反射和直觉得分，LSI主动反射得分和LSTI直觉得分对于确定该人群学习风格的有效性。认知风格和学习风格分数可能无法互换，即使对于具有相似定义的结构也是如此。

BACKGROUND & AIMS: :Molecular biology techniques are applied for the diagnosis of meningoencephalitis due to herpesviruses, enteroviruses or polyomaviruses, for the diagnosis of human cytomegalovirus, human parvovirus B19, varicella-zoster virus and rubella virus infections occurring during pregnancy, for the diagnosis and the management of retrovirus infections (HIV and HTLV) and of hepatitis (HBV and HCV), for papillomavirus typing and to detect a link between virus and clinical manifestations (cardiomyopathy or insulinodependent diabetes with coxsackievirus B: Kaposi's sarcoma with HHV 8) or to investigate an environmental contamination with viruses. These new molecular markers which are both qualitative and quantitative represent an important advance in the field of viral diagnosis research, in the monitoring of viral load during the course of infection, in the therapy control of viral disease and in the epidemiology of virus spread. Standardization and automatization are obtained using available commercial reagents and kits.

背景与目标： ：分子生物学技术被用于诊断由疱疹病毒，肠病毒或多瘤病毒引起的脑膜脑炎，用于诊断人巨细胞病毒，人细小病毒B19，水痘-带状疱疹病毒和风疹病毒在怀孕期间发生的感染，用于诊断和管理逆转录病毒感染（HIV和HTLV）和肝炎（H​​BV和HCV），用于乳头瘤病毒分型并检测病毒与临床表现之间的联系（心肌病或胰岛素依赖型糖尿病与柯萨奇病毒B：卡波西氏肉瘤伴HHV 8）或调查环境污染病毒。这些新的定性和定量分子标记代表了病毒诊断研究领域，感染过程中病毒载量的监测，病毒疾病的治疗控制和病毒传播的流行病学的重要进展。使用可用的市售试剂和试剂盒可获得标准化和自动化。

BACKGROUND & AIMS: BACKGROUND:The literature reports that the learning curve for laparoscopic Roux-en-Y gastric bypass (LRYGBP) is approximately 75-100 cases. This aim of the present study was to evaluate the safety and feasibility of shortening the learning curve for performing LRYGBP by an experienced laparoscopic surgeon. METHODS:This study analyzed retrospectively the first 100 consecutive LRYGBP cases performed by an experienced laparoscopic surgeon between April 2003 and September 2003. The surgeon performed these cases after first assisting in 30 cases, and the first 4 cases were proctored by an experienced laparoscopic bariatric surgeon. Two cases done after previous gastric stapling and Nissen fundoplication were excluded from the study. Outcome variables included operative time, complications, conversion, and mortality. RESULTS:For the first 100 LRYGBP patients, the mean age was 42.6 years (range, 22-62 years) and mean body mass index (BMI) was 47.6 kg/m2 (range, 36-71.8). The complications included 1 case of intestinal leak, 1 case of small bowel obstruction, 6 cases of gastrojejunal stenosis, 8 cases of wound infection, 1 case of wound seroma, and 2 cases of pulmonary embolism, resulting in 1 mortality. One case was converted to an open technique. Over the second 50 cases, there was a significant reduction in mean operative time, to 73 minutes (range, 39-145 minutes) from 113 minutes (range, 54-238 minutes) (P < .0001). However, despite the reduction in complication frequency (no gastrointestinal leak or obstruction, 2 cases of gastrojejunal stenosis, 2 cases of wound infection, no pulmonary embolism/deep venous thrombosis, and no mortality), there was no significant correlation between the mortality, conversion, and complication rates and the surgeon's experience. CONCLUSION:A bariatric surgical practice incorporating LRYGBP can be safely done by an experienced laparoscopic surgeon. With appropriate advanced laparoscopic skills, preparatory steps, proctorship, and adequate volume of cases, the learning curve for performing LRYGBP can be reduced to 50 cases. Further experience is associated with a significant reduction in operative time with acceptable mortality, complication, and conversion rates.

背景与目标： 背景：文献报道腹腔镜Roux-en-Y胃旁路术（LRYGBP）的学习曲线约为75-100例。本研究的目的是评估由经验丰富的腹腔镜外科医生缩短进行LRYGBP学习曲线的安全性和可行性。
方法：本研究回顾性分析了2003年4月至2003年9月由经验丰富的腹腔镜外科医生进行的前100例连续LRYGBP病例。在首次协助30例患者之后，外科医生进行了这些病例，前4例病例由经验丰富的腹腔镜肥胖手术医师督导。该研究排除了先前进行胃吻合术和尼森胃底折叠术后完成的两个病例。结果变量包括手术时间，并发症，转化率和死亡率。
结果：前100名LRYGBP患者的平均年龄为42.6岁（范围22-62岁），平均体重指数（BMI）为47.6 kg / m2（范围36-71.8）。并发症包括肠漏1例，小肠梗阻1例，胃空肠狭窄6例，伤口感染8例，伤口血清肿1例和肺栓塞2例，导致1例死亡。一个案例被转换为开放技术。在后50例中，平均手术时间从113分钟（54-238分钟）减少到73分钟（39-145分钟）（P <.0001）。然而，尽管并发症发生率降低（无胃肠道渗出或阻塞，2例胃肠空肠狭窄，2例伤口感染，无肺栓塞/深静脉血栓形成，无死亡率），但死亡率，转化率之间无显着相关性。 ，并发症发生率和外科医生的经验。
结论：有经验的腹腔镜外科医生可以安全地进行结合了LRYGBP的减肥手术。借助适当的高级腹腔镜检查技巧，准备步骤，指导以及适当的病例数量，可以将进行LRYGBP的学习曲线减少到50例。进一步的经验可以显着减少手术时间，并具有可接受的死亡率，并发症和转化率。

BACKGROUND & AIMS: :Improvements in health care are slow, in part because doctors and nurses lack skills in quality improvement, patient safety, and interprofessional teamwork. This article reports on the Retooling for Quality and Safety initiative of the Josiah Macy Jr. Foundation and the Institute for Healthcare Improvement, which sought to integrate improvement and patient safety into medical and nursing school curricula. In one academic year, 2009-10, the initiative supported new learning activities (87 percent of which were interprofessional, involving both medical and nursing students) in classrooms, simulation centers, and clinical care settings that involved 1,374 student encounters at six universities. The work generated insights-described in this article-into which learning goals require interprofessional education; how to create clinically based improvement learning for all students; and how to demonstrate the effects on students' behavior, organizational practice, and benefits to patients. A commonly encountered limiting factor for the programs was the lack of a critical mass of clinically based faculty members who were ready to teach about the improvement of care. What's more, the paucity of robust evaluation strategies for such programs suggests a future research agenda that deserves to be funded.

背景与目标： ：医疗保健方面的改进缓慢，部分原因是医生和护士缺乏提高质量，患者安全和跨专业团队合作的技能。本文报道了Josiah Macy Jr. Foundation和医疗保健改善研究所的“质量与安全重塑计划”倡议，该倡议旨在将改善和患者安全纳入医疗和护理学校的课程中。在2009-10学年的一个学年中，该计划支持了教室，模拟中心和临床护理环境中的新学习活动（其中87％是跨专业的，涉及医学和护理学的学生），涉及六所大学的1,374名学生。这项工作产生了本文中介绍的见解，其中的学习目标需要跨专业的教育；如何为所有学生创建基于临床的改进学习；以及如何证明对学生的行为，组织实践和对患者的好处的影响。该计划的一个普遍遇到的限制因素是缺乏足够数量的临床教师来准备教授改善护理的知识。而且，此类计划缺乏强有力的评估策略，这表明未来的研究议程值得资助。

BACKGROUND & AIMS: :This study examined postconcussion symptom reporting within the first 5 years after mild traumatic brain injury (mTBI). Participants were 167 U.S. military service members (mean age, 27.6 years; 74.3% blast; 96.4% male) who were evaluated subsequent to injuries sustained in theater during Operations Iraqi and Enduring Freedom (92.8%) or from other combat-related operations. Participants completed the Neurobehavioral Symptom Inventory and Post-Traumatic Stress Disorder Checklist within 3 months of injury and at least one follow-up telephone interview at 6 (n = 46), 12 (n = 89), 24 (n = 54), 36 (n = 42), 48 (n = 30), and/or 60 months (n = 25) postinjury. Approximately half of the sample (49.7%) met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) symptom criteria for postconcussion disorder (PCD) at baseline. At all six follow-ups, 46.1-72.0% met DSM-IV criteria for PCD. However, only 20.4-48.0% reported persistent PCD from baseline to follow-up. A substantial minority had also improved (4.0-24.1%) or "developed" new symptoms (16.9-27.8%). Using regression analyses, baseline symptoms were somewhat predictive of PCD symptom reporting at follow-up, though this was not always reliable. Follow-up for all service members who sustain a combat-related mTBI in the context of polytrauma, regardless of the presence or absence of symptom reporting in the acute recovery stage, should be considered the rule, not the exception.

背景与目标： ：这项研究检查了轻度脑外伤（mTBI）后头5年内脑震荡后症状的报告。参加者有167名美国军人（平均年龄27.6岁；爆炸74.3％；男性96.4％），他们在伊拉克和持久自由行动（92.8％）或其他战斗相关行动的战区受伤后接受了评估。参与者在受伤后3个月内完成了神经行为症状清单和创伤后应激障碍检查清单，并在6（n = 46），12（n = 89），24（n = 54），36进行了至少一次随访电话访谈（n = 42），48（n = 30）和/或受伤后60个月（n = 25）。大约一半的样本（49.7％）在基线时符合脑震荡后疾病（PCD）的精神疾病诊断和统计手册，第四版（DSM-IV）症状标准。在所有六次随访中，46.1-72.0％的患者符合PCD的DSM-IV标准。但是，只有20.4-48.0％的人报告了从基线到随访的持续PCD。相当一部分人也有改善（4.0-24.1％）或“发展”新症状（16.9-27.8％）。使用回归分析，基线症状在某种程度上可以预测随访时PCD症状的报告，尽管这并不总是可靠的。在多发性创伤的情况下维持与战斗有关的mTBI的所有服役人员的随访，无论在急性恢复阶段是否存在症状报告，都应视为常规，而不是例外。

BACKGROUND & AIMS: The health care industry is in the throes of remarkably penetrating and destabilizing change, the effects of which have been felt earliest by perinatal service directors. In anticipation of future trends marked by rampant change, a survey of perinatal service directors and vice presidents was conducted to elicit their opinions about the current and future states of perinatal health care. Findings supported the notions that change is a constant, that clinical and service excellence is a mandate, and that collaboration is key. Future success will require many old behaviors and systems to be replaced. Leadership to guide us to the future has never been more important.

背景与目标： 卫生保健行业正处在深刻渗透和破坏稳定的变革的阵痛之中，围产期服务主管最早感受到了这种变革的影响。为了预见未来变化趋势明显的趋势，对围产期服务主管和副总裁进行了一项调查，以征询他们对围产期保健的当前和未来状态的意见。研究结果支持以下观念：变革是永恒的，临床和服务卓越是使命，协作是关键。未来的成功将需要替换许多旧的行为和系统。引领我们走向未来的领导力从未如此重要。

BACKGROUND & AIMS: :"First responders" are people trained in advanced first aid who can respond at the same time as, and often more quickly than, ambulance services to suspected medical emergencies. Hatzolah is a volunteer First Responder group, based on halakhic (Jewish legal) principles, in a localised area of metropolitan Melbourne with the highest density of Holocaust survivors outside Israel. Low numbers of "call-outs" to Victoria's Metropolitan Ambulance Service (MAS) from this community suggested that many were reluctant to make contact with a "uniformed" external agency. Hatzolah is an autonomous organisation operating under adapted MAS clinical practice guidelines and clinical governance processes. Hatzolah responders undergo an 18-month MAS training course comprising first aid, cardiopulmonary resuscitation, the use of semiautomated defibrillators, and oxygen therapy. We describe the first 11 years (1995-2005) of the Hatzolah service. The number of patients attended to annually has risen steadily, peaking at 867 in 2005. The most frequent reasons for call-outs were falls (19.4%), chest pain (9.7%), or respiratory distress (7.6%). Hatzolah's median response times were 2 or 3 min for all cases. They attended 35 patients with cardiac arrest (median response time, 2 min), and arrived before the MAS to 29 call-outs (83%). Nineteen patients (54%) with cardiac arrest were resuscitated and transported from the scene alive. Among those transported, significantly more had a shockable cardiac rhythm (50% v 13%, P = 0.03). Five (14%) survived to hospital discharge. Hatzolah has evolved into an organisation providing a complementary service to the MAS. It serves as a model for the establishment of other metropolitan community First Responder groups.

背景与目标： ：“急救人员”是受过高级急救训练的人员，可以与救护车服务同时对可疑医疗紧急情况做出响应，并且通常比救护车服务更快。哈佐拉（Hatzolah）是自愿响应的“第一响应者”团体，基于犹太人（犹太法律）原则，在墨尔本以外的以色列大屠杀幸存者密度最高的大都市墨尔本本地区域中。来自该社区的维多利亚大都会救护车服务（MAS）的“召集”次数很少，这表明许多人不愿与“统一”的外部机构进行联系。 Hatzolah是根据适应性MAS临床实践指南和临床治理流程运作的自治组织。 Hatzolah响应者接受为期18个月的MAS培训课程，包括急救，​​心肺复苏，半自动除颤器的使用和氧气疗法。我们描述了Hatzolah服务的前11年（1995-2005年）。每年看病的人数一直稳定增长，在2005年达到867例的峰值。最常见的原因是跌倒（19.4％），胸痛（9.7％）或呼吸窘迫（7.6％）。在所有情况下，Hatzolah的中位反应时间均为2或3分钟。他们治疗了35例心脏骤停的患者（中位反应时间为2分钟），并在MAS之前到达了29个呼出处（83％）。复苏了19例心脏骤停患者（54％），并从现场转移了生命。在被转运的人中，明显的人具有令人震惊的心律（50％对13％，P = 0.03）。五（14％）人存活到医院出院。 Hatzolah已发展成为向MAS提供补充服务的组织。它是建立其他大都市社区“第一响应者”团体的典范。

BACKGROUND & AIMS: :Thirty-five patients with definite multiple sclerosis (MS) were studied. They underwent neuropsychological testing and magnetic resonance imaging (MRI). The MRI findings at different brain areas levels were compared with the neuropsychological findings. A quantitative system was used to measure MRI-MS lesions. In this series, a positive correlation was established between memory and learning disturbances measured by Battery 144, and the lesions measured by MRI (total, hemispheric and, particularly, periventricular lesions). MRI can detect MS lesions, and this study shows that a correlation between MRI and neuropsychological findings is possible if quantitative methods are used to distinguish different MS involvement areas in relation to neuropsychological tasks. These findings suggest that hemispheric lesions in MS produce cognitive disturbances and MRI could be a useful tool in predicting memory and learning impairment.

背景与目标： ：研究了35例明确的多发性硬化症（MS）患者。他们接受了神经心理学测试和磁共振成像（MRI）。将不同大脑区域水平的MRI检查结果与神经心理学检查结果进行比较。定量系统用于测量MRI-MS病变。在这个系列中，通过电池144测量的记忆和学习障碍与通过MRI测量的病变（总的，半球的，尤其是脑室周围的病变）之间建立了正相关。 MRI可以检测MS病变，这项研究表明，如果使用定量方法区分与神经心理学任务相关的不同MS累及区域，则MRI与神经心理学发现之间可能存在关联。这些发现表明，MS的半球病变会产生认知障碍，而MRI可能是预测记忆和学习障碍的有用工具。

BACKGROUND & AIMS: BACKGROUND:Patient satisfaction, one of the main components of quality of care, is a crucial phenomenon for the overall health care delivery system. Even though a number of studies have been conducted about patient satisfaction in different health services, studies in radiology services are flimsy in Ethiopia. This study aimed at assessing patient satisfaction towards radiological service and associated factors in Hawassa University Teaching and Referral hospital. METHODS:An institution based cross-sectional study was conducted among 321 adult patients presented for radiological service in the study area using stratified sampling technique. Patient satisfaction was measured using SERVQUAL (Service Quality) tool that consisted of seven items: accessibility, quality of radiological service, courtesy of radiology staff, existence of good communication with service provider and desk worker, physical environment and privacy technique. Exit interviews of patients were conducted using a structured and pretested questionnaire. Data was collected by three grade ten completed trained data collectors from May 12 to May 28, 2016. Multiple logistic regressions were used to identify independent factors associated with patient satisfaction on radiological services using SPSS version 21. RESULTS:The overall patient satisfaction towards radiological service was 71.6%. Satisfaction to accessibility of the service was 84.5% while it was 80.6% to courtesy of the staff. Similarly, 81.6% reported satisfied with quality of the service and 59.4% and 71% of reported satisfied with physical environment and radiological service provider respectively. On the other hand, 99.7% of the respondents were dissatisfied with privacy of the service. The study revealed that patients who attended primary school (AOR = 0.317, 95% CI: 0.11-0.88), unemployed patients (AOR = 0.067, 95% CI: 0.007-0.622) and patients who had short waiting time to enter into examination room less than one hour (AOR = 4.12, 95% CI: 1.4-11.62) were factors associated with patients satisfaction. CONCLUSION:This study found that majority of respondents was satisfied with the radiological services. Respondent's education level, occupation as well as duration of time taken to enter into examination room were important factors influencing the satisfaction condition. Hence, concerted effort is needed to constantly improve on patient satisfaction to better radiology returns arising from improved patient patronage. It is recommended to give great care and attention to clients during radiological examination procedure and also suggested that the department should decrease time taken to enter into examination room. On the other hand, the reasons behind more educated clients were less satisfied with radiologic service than more educated respondents need further investigation.

背景与目标： 背景：患者满意度是医疗质量的主要组成部分之一，是整个医疗服务体系中的关键现象。即使在不同的卫生服务机构中进行了许多有关患者满意度的研究，但在埃塞俄比亚，放射科的研究仍然很薄弱。这项研究旨在评估霍瓦萨大学教学与转诊医院对放射服务及相关因素的患者满意度。
方法：采用分层抽样技术，对研究区的321名成年放射科成年患者进行了基于机构的横断面研究。使用SERVQUAL（服务质量）工具测量患者满意度，该工具包括七个项目：可访问性，放射线服务质量，放射线人员的礼貌，与服务提供者和服务台工作人员的良好沟通，身体环境和隐私技术。使用结构化且经过预先测试的问卷对患者进行出站采访。数据由2016年5月12日至2016年5月28日由三个十位完成培训的十年级数据收集者收集。使用Logistic回归分析使用SPSS 21版使用放射线回归确定与患者对放射服务的满意度相关的独立因素。
结果：患者对放射科服务的总体满意度为71.6％。对该服务的可访问性满意度为84.5％，而工作人员的礼貌满意度为80.6％。同样，分别对服务质量表示满意的有81.6％，对物理环境和放射服务提供者表示满意的有59.4％和71％。另一方面，有99.7％的受访者对服务的私密性不满意。研究显示，上小学的患者（AOR = 0.317，95％CI：0.11-0.88），失业的患者（AOR = 0.067，95％CI：0.007-0.622）和等待时间短的患者进入考场少于一小时（AOR = 4.12，95％CI：1.4-11.62）是与患者满意度相关的因素。
结论：本研究发现大多数受访者对放射学服务感到满意。受访者的文化程度，职业以及进入考场的时间是影响满意度的重要因素。因此，需要共同努力以不断提高患者的满意度，以改善患者的光顾，从而获得更好的放射学回报。建议在放射检查过程中要格外注意和照顾客户，并建议部门减少进入检查室的时间。另一方面，受过良好教育的客户对放射线服务的满意度低于对受过教育的受访者的满意度，这是需要进一步调查的原因。

BACKGROUND & AIMS: :Patient safety is one of the greatest challenges facing health care today and nurses are well placed to find opportunities for enhancing care and making it safer. Nurse education has an important role to play in ensuring future professions have capabilities and confidence to meet this challenge however this requires new pedagogies in nurse education. This paper reports on an initiative to develop the safety improvement and leadership capabilities of final year nursing students using Action Learning to support students to undertake a safety improvement project in the clinical setting. A qualitative, interpretive research approach was used to explore students' experiences of participation in Action Learning. 52 nursing students from a UK University participated in the study. Student accounts of their experiences were generated through focus group and individual interviews and data were subject to thematic analysis. Findings are discussed in relation to three categories including "creating an enabling environment", "learning through action and reflection" and "the emergence of safety improvement and leadership practices." The study findings provide valuable insights into how AL processes can engender personal leadership capabilities and support students to make a valuable contribution to safer care practices, both as students and as future health care professionals.

背景与目标： ：患者的安全性是当今医疗保健面临的最大挑战之一，护士已准备好寻找机会来加强护理并使其更加安全。护士教育在确保未来的职业具有应对这一挑战的能力和信心方面可以发挥重要作用，但这需要在护士教育中采用新的教学法。本文报告了一项旨在通过行动学习来发展最终护理学生的安全改进和领导能力的倡议，以支持学生在临床环境中开展安全改进项目。使用定性，解释性研究方法来探索学生参与行动学习的经验。来自英国大学的52名护理专业学生参加了这项研究。通过专题小组对学生的经历进行描述，并通过专题访谈对个人访谈和数据进行分析。讨论了与三个类别有关的发现，包括“创造有利的环境”，“通过行动和反思进行学习”以及“安全改进和领导实践的出现”。研究结果为AL过程如何提高个人领导能力和支持学生（无论是作为学生还是将来的医疗保健专业人员）对更安全的护理实践做出了宝贵的贡献提供了宝贵的见解。

BACKGROUND & AIMS: OBJECTIVES:To determine the willingness of accountable care organizations (ACOs) to bear financial risk for the healthcare they provide. DESIGN AND METHODS:Structured interviews conducted between January and June 2012 with 57 ACOs led by hospitals and physician groups located throughout the United States. Findings are based on the 38 ACOs that were actively providing care under an ACO payment arrangement at the time of the interview. RESULTS:Among these ACOs, 71% cover a portion of their ACO population with contracts that put the ACOs at some financial risk, while 45% have risk-based contracts for their entire ACO population. Payments based on fee-for-service (FFS) billing still dominate, as 92% of ACOs use FFS-based billing for at least a portion of their ACO population and 71% are fully reimbursed using FFS-based billing. CONCLUSIONS:Under the auspices of an ACO, providers are accepting some financial risk for their accountable care patient population. There is still strong reliance on FFS-based billing methods as providers experiment with different payment models.

背景与目标： 目的：确定责任医疗组织（ACO）承担为其提供的医疗服务承担财务风险的意愿。
设计与方法：2012年1月至6月间对57个ACO（由美国各地的医院和医师小组领导）进行了结构化访谈。调查结果基于采访时根据ACO付款安排积极提供护理的38个ACO。
结果：在这些ACO中，有71％的合同覆盖了一部分ACO人群，使ACO承受了一定的财务风险，而45％的合同中有针对整个ACO人群的基于风险的合同。基于服务费（FFS）计费的付款仍然占主导地位，因为92％的ACO至少有一部分ACO人口使用基于FFS的计费，而71％的ACO使用基于FFS的计费完全偿还。
结论：在ACO的主持下，提供者正在为其负责的护理患者群体承担一些财务风险。由于提供商尝试使用不同的支付模型，因此仍然强烈依赖基于FFS的计费方法。

BACKGROUND & AIMS: :Mutation of the DNA-binding region of the FOXP2 protein causes an inherited language disorder. A recent study provides the first data on mice with this mutation, which exhibit deficits in motor-skill learning and abnormal properties of neural circuits that contribute to these skills.

背景与目标： ：FOXP2蛋白的DNA结合区的突变会导致遗传性语言障碍。最近的一项研究提供了具有这种突变的小鼠的首批数据，这些小鼠表现出运动技能学习的缺陷和有助于这些技能的神经回路异常特性。

BACKGROUND & AIMS: :We have previously shown in normal subjects that motor adaptation to imposed visual rotation is significantly enhanced when tested few days later. This occurs through a process of sleep-dependent memory consolidation. Here we ascertained whether patients with Parkinson's disease (PD) learn, improve, and retain new motor skills in the same way as normal subjects. We tested 16 patients in early stages of PD and 21 control subjects over two days. All subjects performed reaching movements on a digitizing tablet. Vision of the limb was precluded with an opaque screen; hand paths were shown on the screen with the targets' position. Unbeknownst to the subjects, the hand path on the screen was rotated by 30 degrees . In experiment 1, patients taking dopaminergic treatment and controls adapted to rotation with targets appearing in an unpredictable order. In experiment 2, drug-naïve patients and controls adapted to rotation in a less challenging task where target's appearance was predictable. Patients and controls made similar movements and adapted to rotation in the same way. However, when tested again over the following days, controls' performance significantly improved compared to training, while patients' performance did not. This lack of consolidation, which is present in the early stages of the disease and is independent from therapy, may be due to abnormal homeostatic processes that occur during sleep.

背景与目标： ：我们之前在正常受试者中显示，几天后进行测试后，运动适应视觉旋转的能力会大大增强。这是通过依赖于睡眠的内存合并过程来发生的。在这里，我们确定帕金森氏病（PD）的患者是否以与正常受试者相同的方式学习，改善和保留新的运动技能。我们在两天内测试了PD早期的16例患者和21例对照对象。所有对象均在数字化平板电脑上进行了移动动作。不透明的屏幕无法显示四肢的视力；屏幕上显示了目标位置的手形路径。被摄对象不知道，屏幕上的手部路径旋转了30度。在实验1中，接受多巴胺能治疗和控制的患者适应了旋转，并且靶标以无法预测的顺序出现。在实验2中，没有药物治疗的患者和对照组在难以预测的任务中适应了旋转，其中目标的出现是可预测的。患者和对照者进行相似的运动，并以相同的方式适应旋转。但是，在接下来的几天中再次进行测试时，与训练相比，对照组的表现显着改善，而患者的表现却没有。这种缺乏固结的现象是在疾病的早期阶段出现的，并且与治疗无关，这可能是由于睡眠期间发生的异常体内平衡过程引起的。

BACKGROUND & AIMS: :K. Cheng (1986) suggested that learning the geometry of enclosing surfaces takes place in a geometric module blind to other spatial information. Failures to find blocking or overshadowing of geometry learning by features near a goal seem consistent with this view. The authors present an operant model in which learning spatial features competes with geometry learning, as in the Rescorla-Wagner model. Relative total associative strength of cues at a location determines choice of that location and thus the frequencies of reward paired with each cue. The model shows how competitive learning of local features and geometry can appear to result in potentiation, blocking, or independence, depending on enclosure shape and kind of features. The model reproduces numerous findings from dry arenas and water mazes.

背景与目标： ：K Cheng（1986）建议，学习封闭表面的几何形状是在对其他空间信息不了解的几何模块中进行的。未能通过目标附近的要素找到阻碍或过度学习几何学习的现象似乎与此视图一致。作者提出了一个操作模型，其中与Rescorla-Wagner模型一样，学习空间特征与几何学习竞争。某个位置的提示的相对总关联强度决定了该位置的选择，并因此决定了与每个提示配对的奖励频率。该模型显示了根据局部形状和特征种类，竞争性学习局部特征和几何形状会如何导致增强，阻断或独立性。该模型重现了来自干竞技场和迷宫般的大量发现。