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。

BACKGROUND & AIMS: :Recognizing that robust information on health systems in other countries can provide valuable lessons for the English National Health Service, the Department of Health commissioned an academic team to provide an 'On-call Facility for International Healthcare Comparisons' in 2005. This paper describes the work of this novel approach to informing policy and reviews the experience of the first two years. It illustrates the well-documented challenges of comparative analysis of health systems. One important issue is understanding the health system context so as to interpret phenomena and draw appropriate policy conclusions. Other challenges include the potential tension between academic interest and rigour, and the need for timely analysis to inform the Department of Health's rapidly changing policy agenda. The diversity and nature of topics covered, as well as the rapid turn-around time have meant that the Facility has had to balance rigour and timeliness carefully to ensure the value and relevance of reports. A strong research base linked with an international network of country experts promotes the provision of high quality analyses at relatively low costs. However, such an arrangement can only be sustained if it provides scope for additional primary research. A formal evaluation of the influence on health care policy-making in England is not yet available. Such knowledge will be of crucial importance for the development of similar resources elsewhere.

背景与目标： ：卫生部认识到其他国家/地区强大的卫生系统信息可以为英国国家卫生服务局提供宝贵的经验，因此在2005年委托一个学术团队提供“国际医疗比较的待命服务”。这种新颖的方法来指导政策并回顾前两年的经验。它说明了卫生系统比较分析中有据可查的挑战。一个重要的问题是了解卫生系统的背景情况，以便解释现象并得出适当的政策结论。其他挑战包括学术兴趣和严格性之间的潜在紧张关系，以及需要及时分析以告知卫生部迅速变化的政策议程的挑战。所涉主题的多样性和性质以及快速的周转时间，意味着该基金必须认真权衡严格性和及时性，以确保报告的价值和相关性。强大的研究基础与国家专家的国际网络相联系，促进了以相对较低的成本提供高质量的分析。但是，只有为其他基础研究提供了范围，这样的安排才能维持下去。目前尚无关于英格兰对卫生保健政策制定影响的正式评估。这些知识对于开发其他地方的类似资源至关重要。

BACKGROUND & AIMS: OBJECTIVES:To examine attitudes to the Mental Capacity Act's new statutory Independent Mental Capacity Advocate (IMCA) service in England and Wales and consider the implications for its delivery. METHODS:Quantitative data describing all referrals to the seven pilot IMCA services (January 2006-March 2007) and qualitative data from semi-structured interviews with 18 doctors, 21 senior nurses and one discharge planning manager in four general hospitals in England. RESULTS:Of 127 hospital-based referrals to the seven pilot IMCA services, 29 (23%) were for patients facing serious medical treatments, 52% of whom were judged to lack decision-making capacity due to a learning disability; ninety-eight (77%) were for patients facing a change of accommodation upon hospital discharge, 62% of whom were elderly and lacked capacity due to dementia. While aware of the potential benefits of the IMCA service, clinicians were generally negative about the contribution advocates could make to patients' medical care and thought they could only contribute usefully in a minority of ethically complicated decisions. In contrast, they were more positive about the involvement of advocates in hospital discharge decisions and hoped that they would improve current discharge practice. CONCLUSIONS:Clinicians held ambivalent attitudes towards the involvement of a statutory IMCA service in medical decisions, reflecting beliefs that the service was largely impractical and unnecessary given current procedures for making medical decisions in patients' 'best interests'. Conversely, clinicians were more likely to support advocacy in discharge decisions because they believed that non-medically qualified advocates could make a valuable contribution to decisions that were seen as predominantly social and where practice was frequently considered deficient. By holding these beliefs, clinicians are failing to have due regard for the IMCA service as a statutory measure for safeguarding patients' interests.

背景与目标： 目的：研究对《心理能力法案》在英格兰和威尔士新成立的法定独立心理能力提倡者（IMCA）服务的态度，并考虑对其实施的影响。
方法：定量数据描述了所有转诊给七个IMCA试点服务（2006年1月至2007年3月）的数据，以及来自与英格兰四家综合医院的18位医生，21位高级护士和一位出院计划经理进行的半结构式访谈的定性数据。
结果：在七项IMCA试点服务的127例医院转诊中，有29例（23％）是针对面临严重医疗的患者，其中52％被判定为因学习障碍而缺乏决策能力；百分之九十八（77％）的病人是出院后面临住宿变更的患者，其中62％为老年人且因痴呆症而无能力。在意识到IMCA服务的潜在好处的同时，临床医生通常对倡导者可以对患者的医疗服务做出的贡献持否定态度，并认为他们只能在少数道德上复杂的决定中做出有益的贡献。相反，他们对倡导者参与医院出院决定更为积极，并希望他们能够改善目前的出院实践。
结论：临床医生对将法定IMCA服务纳入医疗决策持矛盾态度，反映出这样一种信念，即鉴于当前为患者“最大利益”做出医疗决策的程序，该服务在很大程度上是不切实际和不必要的。相反，临床医生更有可能支持出院决策方面的倡导，因为他们认为没有医学资历的倡导者可以为那些被认为主要是社会行为且经常被认为缺乏实​​践的决策做出有价值的贡献。抱着这些信念，临床医生就没有适当考虑IMCA服务作为保护患者利益的法定措施。

BACKGROUND & AIMS: BACKGROUND:Word sense disambiguation (WSD) is critical in the biomedical domain for improving the precision of natural language processing (NLP), text mining, and information retrieval systems because ambiguous words negatively impact accurate access to literature containing biomolecular entities, such as genes, proteins, cells, diseases, and other important entities. Automated techniques have been developed that address the WSD problem for a number of text processing situations, but the problem is still a challenging one. Supervised WSD machine learning (ML) methods have been applied in the biomedical domain and have shown promising results, but the results typically incorporate a number of confounding factors, and it is problematic to truly understand the effectiveness and generalizability of the methods because these factors interact with each other and affect the final results. Thus, there is a need to explicitly address the factors and to systematically quantify their effects on performance. RESULTS:Experiments were designed to measure the effect of "sample size" (i.e. size of the datasets), "sense distribution" (i.e. the distribution of the different meanings of the ambiguous word) and "degree of difficulty" (i.e. the measure of the distances between the meanings of the senses of an ambiguous word) on the performance of WSD classifiers. Support Vector Machine (SVM) classifiers were applied to an automatically generated data set containing four ambiguous biomedical abbreviations: BPD, BSA, PCA, and RSV, which were chosen because of varying degrees of differences in their respective senses. Results showed that: 1) increasing the sample size generally reduced the error rate, but this was limited mainly to well-separated senses (i.e. cases where the distances between the senses were large); in difficult cases an unusually large increase in sample size was needed to increase performance slightly, which was impractical, 2) the sense distribution did not have an effect on performance when the senses were separable, 3) when there was a majority sense of over 90%, the WSD classifier was not better than use of the simple majority sense, 4) error rates were proportional to the similarity of senses, and 5) there was no statistical difference between results when using a 5-fold or 10-fold cross-validation method. Other issues that impact performance are also enumerated. CONCLUSION:Several different independent aspects affect performance when using ML techniques for WSD. We found that combining them into one single result obscures understanding of the underlying methods. Although we studied only four abbreviations, we utilized a well-established statistical method that guarantees the results are likely to be generalizable for abbreviations with similar characteristics. The results of our experiments show that in order to understand the performance of these ML methods it is critical that papers report on the baseline performance, the distribution and sample size of the senses in the datasets, and the standard deviation or confidence intervals. In addition, papers should also characterize the difficulty of the WSD task, the WSD situations addressed and not addressed, as well as the ML methods and features used. This should lead to an improved understanding of the generalizablility and the limitations of the methodology.

背景与目标： 背景：字词歧义消除（WSD）在生物医学领域对于提高自然语言处理（NLP），文本挖掘和信息检索系统的精度至关重要，因为歧义词会对准确访问包含生物分子实体（例如基因）的文献产生负面影响蛋白质，细胞，疾病和其他重要实体。已经开发出自动技术来解决许多文本处理情况下的WSD问题，但是该问题仍然是一个具有挑战性的问题。有监督的WSD机器学习（ML）方法已应用于生物医学领域，并显示出令人鼓舞的结果，但结果通常包含许多混杂因素，并且由于这些因素相互影响，真正了解这些方法的有效性和可推广性是有问题的彼此影响最终结果。因此，需要明确解决这些因素并系统地量化其对性能的影响。
结果：设计了实验来测量“样本量”（即数据集的大小），“感官分布”（即歧义词的不同含义的分布）和“难易程度”（即歧义词的含义之间的距离）对WSD分类器的性能。支持向量机（SVM）分类器应用于自动生成的数据集，该数据集包含四个歧义生物医学缩写：BPD，BSA，PCA和RSV，这是由于它们各自含义上的差异程度不同而选择的。结果表明：1）增加样本大小通常会降低错误率，但这主要限于良好分离的感官（即，感官之间的距离较大的情况）；在困难的情况下，需要极大地增加样本数量以略微提高性能，这是不切实际的； 2）当感官可分离时，感官分布对性能没有影响； 3）当多数感官超过90时％，WSD分类器并不比使用简单多数感官更好； 4）错误率与各种感官的相似性成正比； 5）使用5倍或10倍交叉比对时结果之间没有统计学差异验证方法。还列举了影响性能的其他问题。
结论：将ML技术用于WSD时，有几个不同的独立方面会影响性能。我们发现将它们组合成一个单一的结果会模糊对基本方法的理解。尽管我们仅研究了四个缩写，但我们使用了一种完善的统计方法，该方法可以保证结果对于具有相似特征的缩写很可能是可推广的。我们的实验结果表明，为了了解这些ML方法的性能，至关重要的是，论文要报告基线性能，数据集中感官的分布和样本大小以及标准偏差或置信区间。此外，论文还应描述WSD任务的难度，WSD解决和未解决的情况以及所使用的ML方法和功能。这应该导致人们对通用性和方法的局限性有了更好的了解。

BACKGROUND & AIMS: :Forty patients who had been treated for three years in an ad-hoc, assertive treatment team for patients who had suffered a first psychotic episode were compared to forty patients who had been followed up after a first psychotic episode in a community mental health team. All patients had suffered a first or early psychotic episode. The main differences between the two teams was that the ad-hoc team was assertive in its approach, offered more structured psycho-education, relapse prevention and psycho-social interventions, and had a policy of using atypical anti-psychotics at the lowest effective dose. There were many differences in outcome measures at the end of three years between the two groups. The EI patients are more likely to be taking medication at the end of three years. They are more compliant with medication. They are more likely to be prescribed atypical medication. The EI patients are more likely to have returned to work or education. The EI patients are more likely to remain living with their families. They are less likely to suffer depression to the extent of requiring anti-depressants. They appear to commit less suicide attempts. The patients in the EI service also appear to be less likely to suffer relapse and re-hospitalisation, and are less likely to have involuntary admission to hospital. They have systematic relapse prevention plans based on early warning signs. They and their families receive more psycho-education. These indications suggest that the EI patients are at the end of three years better able to manage their illness/vulnerability on their own than the CMHT patients. More patients in the EI group stopped using illicit drugs than in the CMHT group. All the above changes were statistically significant except for the number of patients who stopped using illicit drugs. In this case it is believed that the sample size was too small to demonstrate significance. These results suggest that an ad-hoc early intervention team is more effective than standard community mental health team in treating psychotic illness.

背景与目标： ：在社区精神卫生小组中，对在首次精神病发作后接受特设，果断治疗团队治疗的40名患者与在第一次精神病发作后进行了随访的40位患者进行了比较。所有患者均经历了第一次或早期精神病发作。这两个团队之间的主要区别在于，特设团队在方法上很果断，提供了更结构化的心理教育，预防复发和心理社会干预，并制定了以最低有效剂量使用非典型抗精神病药的政策。两组在三年结束时的结局指标之间存在许多差异。 EI患者在三年结束时更有可能服用药物。他们对药物的依从性更高。他们更有可能被开具非典型药物。 EI患者更有可能重返工作岗位或接受教育。 EI患者更有可能继续与家人同住。他们不太可能因需要抗抑郁药而患上抑郁症。他们似乎没有自杀的企图。 EI服务中的患者似乎也不太可能遭受复发和再次住院，并且也不太可能自愿住院。他们根据预警信号制定了系统的预防复发计划。他们和他们的家人接受了更多的心理教育。这些迹象表明，与CMHT患者相比，EI患者在三年结束时能够更好地自行控制疾病/脆弱性。与CMHT组相比，EI组中停止使用违禁药物的患者更多。除停止使用违禁药物的患者人数外，以上所有变化均具有统计学意义。在这种情况下，可以认为样本量太小而无法显示出显着性。这些结果表明，特设的早期干预小组在治疗精神病方面比标准的社区精神卫生小组更有效。

BACKGROUND & AIMS: :Tuberculosis (TB) is an enormous global public health problem. Cases of extensively drug-resistant TB (XDR-TB) are being reported in increasing numbers across the globe. A large outbreak of XDR-TB associated with rapid and nearly universal mortality has been reported among patients with human immunodeficiency virus infection or acquired immunodeficiency disease in South Africa who have been receiving standard TB therapy and antiretrovirals. Epidemiologic features of this outbreak make it highly suspicious for health care-associated transmission. We urge the Infectious Diseases Society of America and its members to increase involvement in ongoing international TB prevention and treatment efforts and to develop a registry of experts in infection control and laboratory and disease management. We urge advocacy for increased funding for domestic and global TB control programs, including expanded access to sputum culture and drug susceptibility testing, as well as funding for TB clinical trials and research capacity. We believe that substandard TB diagnostic tests are not acceptable for TB control in resource-poor countries. We urge the development of shorter, less toxic TB treatment and prevention regimens. Funding of TB control and research should be reassessed to prevent budget cuts at a time when the disease is killing as many as 2 million people a year.

背景与目标： 结核病（TB）是一个巨大的全球公共卫生问题。在全球范围内，越来越多的人报告了广泛耐药的结核病（XDR-TB）病例。在南非，已经接受标准结核病治疗和抗逆转录病毒药物治疗的人类免疫缺陷病毒感染或获得性免疫缺陷疾病患者中，广泛的XDR-TB暴发已被报道。该暴发的流行病学特征使其高度怀疑与卫生保健有关的传播。我们敦促美国传染病学会及其成员增加对正在进行的国际结核病预防和治疗工作的参与，并发展感染控制以及实验室和疾病管理专家名录。我们敦促倡导增加对国内和全球结核病控制计划的资金投入，包括扩大对痰培养和药物敏感性测试的访问，以及为结核病临床试验和研究能力提供资金。我们认为，在资源匮乏的国家，不合格的结核病诊断检测对于控制结核病是不可接受的。我们敦促开发更短，毒性更小的结核病治疗和预防方案。在结核病每年导致多达200万人死亡的时候，应该重新评估结核病控制和研究的经费，以防止预算削减。

BACKGROUND & AIMS: :Simulation offers an important context for clinical education, providing a structured, safe and supportive environment bridging the classroom and the clinic. Two trends in the simulation community appear to be developing uncritically and without adequate evaluation. First, there is a fascination with seductive high-fidelity simulation realized through sophisticated technology. Second, simulation has increasingly appropriated learning in the psychological domain, such as communication skills, under the rationale of 'integration'. Developments in simulation activities have largely been made in a theoretical vacuum and where theory is invoked it is learning theory rather than theory of simulation. This paper introduces theories of simulation from cultural studies as a critical balance to the claims of the simulation community. Work-based and simulation-based learning could engage in a new dialogue for an effective clinical education.

背景与目标： ：模拟为临床教育提供了重要的环境，为架设教室和诊所提供了结构化，安全和支持性的环境。在模拟社区中，有两种趋势似乎正在不加批判地发展，并且没有进行充分的评估。首先，对通过复杂技术实现的诱人的高保真度模拟着迷。其次，在“整合”的基本原理下，模拟越来越适合在心理学领域中进行学习，例如交流技巧。模拟活动的发展很大程度上是在理论真空中进行的，在其中调用理论的是学习理论而不是模拟理论。本文介绍了文化研究中的模拟理论，作为对模拟社区主张的重要平衡。基于工作和基于模拟的学习可以参与新的对话，以进行有效的临床教育。

BACKGROUND & AIMS: :The neurokinin Substance P (SP) is widely distributed in the central nervous system and has been extensively studied in various functional aspects. This review focuses on the behavioral relevance of SP. Here we show that SP can have memory-promoting, reinforcing and anxiolytic-like effects when administered systemically or into the nucleus basalis of the ventral pallidum. These effects seem to be mediated via the SP-preferring NK(1)receptor and differentially related to N- versus C-terminal fragments of the undecapeptide. Secondly, SP injection into the ventral pallidum can lead to increases of acetylcholine in frontal cortex and dopamine in nucleus accumbens, suggesting that the hypermnestic, positively reinforcing and anxiolytic effects observed upon basal forebrain injection of SP are mediated by activation of the nucleus accumbens-ventral pallidum circuitry. Furthermore, SP and certain SP-fragments may not only be considered to have beneficial behavioral effects in normal animals, but can also prevent lesion-induced functional deficits and improve the speed of recovery. This indicates that SP agonists might also have a neuroprotective capacity in parallel with recovery-promoting actions.

背景与目标： ：神经激肽P（SP）广泛分布于中枢神经系统，并已在各个功能方面进行了广泛研究。这篇综述着重于SP的行为相关性。在这里我们表明，当全身或腹侧苍白球的核基底层给药时，SP可以具有促进记忆，增强和抗焦虑的作用。这些作用似乎是通过SP优先的NK（1）受体介导的，并且与十一肽的N端和C端片段差异相关。其次，向腹侧苍白球注射SP可导致额叶皮层中的乙酰胆碱和伏隔核中的多巴胺增加，这表明SP前基底脑注入的高记忆力，正增强和抗焦虑作用是由伏隔核-腹膜的激活介导的。苍白的电路。此外，SP和某些SP片段不仅可以被认为在正常动物中具有有益的行为效果，而且还可以防止病变引起的功能缺陷并提高恢复速度。这表明SP激动剂可能还具有促进恢复作用的神经保护能力。

BACKGROUND & AIMS: INTRODUCTION:Recently, growing interest emerged in the enhancement of human potential by means of non-invasive brain stimulation. In particular, anodal transcranial direct current stimulation (atDCS) has been shown to exert beneficial effects on motor and higher cognitive functions. However, the majority of transcranial direct current stimulation (tDCS) studies have assessed effects of single stimulation sessions that are mediated by transient neural modulation. Studies assessing the impact of multiple stimulation sessions on learning that may induce long-lasting behavioural and neural changes are scarce and have not yet been accomplished in the language domain in healthy individuals. METHOD:The present study probed the potential of atDCS to enhance language learning over multiple days by employing an explicit word learning paradigm. Forty healthy young participants were randomized to learning with either simultaneous atDCS or sham stimulation (N = 20/group; comparable regarding demographic variables and neurocognitive status). All participants acquired a novel vocabulary (familiar and novel object picture - non-word pairs) over five consecutive days. Two memory tasks (free recall; forced choice recognition tasks) were administered immediately after each training session. A one week follow-up tested the maintenance of learning success. RESULTS:Linear mixed effects model analysis revealed superior learning during atDCS compared to sham stimulation for both familiar and novel objects. atDCS yielded a steeper learning curve and significantly more pronounced learning at the end of the training during the recall task. During the recognition task, the atDCS group reached ceiling levels earlier and overall learning success was greater. For both tasks, beneficial atDCS effects were maintained during the follow-up assessment. CONCLUSIONS:The present study provides direct evidence that atDCS administered during multiple learning sessions facilitates language learning and that effects are maintained over time. This study contributes important novel information about the extent of stimulation effects in the healthy brain, thereby highlighting the potential of atDCS to enhance language recovery after stroke.

背景与目标： 简介：最近，人们越来越关注通过无创性脑刺激来增强人类潜能。特别是，阳极经颅直流电刺激（atDCS）已显示出对运动和更高的认知功能产生有益作用。但是，大多数经颅直流电刺激（tDCS）研究已经评估了由短暂神经调节介导的单个刺激阶段的效果。评估多种刺激对学习的影响的研究可能会导致持久的行为和神经变化，但目前尚缺乏健康人在语言领域进行的研究，这些研究尚未完成。
方法：本研究探讨了atDCS通过采用显式单词学习范例在多天内增强语言学习的潜力。 40名健康的年轻参与者被随机分配到同时进行DCS或假刺激的学习中（N = 20 /组;在人口统计学变量和神经认知状态方面可比）。所有参与者都连续五天获得了新颖的词汇表（熟悉的事物和新颖的事物图片-非单词对）。每次训练后，立即执行两个记忆任务（自由回忆；强制选择识别任务）。为期一周的随访测试了学习成功的维持情况。
结果：线性混合效应模型分析显示，与熟悉刺激和新颖物体的假刺激相比，atDCS期间的学习效果更好。在召回任务期间的培训结束时，atDCS产生了更陡峭的学习曲线，并且学习效果明显提高。在识别任务期间，atDCS组更早达到最高级别，并且整体学习成功更大。对于这两项任务，在后续评估期间都保持了atDCS的有益效果。
结论：本研究提供了直接的证据，表明在多次学习中使用atDCS可以促进语言学习，并且效果会随着时间的推移而保持。这项研究提供了有关健康大脑中刺激作用程度的重要新信息，从而突出了atDCS增强中风后语言恢复的潜力。