BACKGROUND & AIMS: PURPOSE:Consistent condom use is critical to efforts to prevent sexually transmitted infections among adolescents, but condom use may decline as relationships and contraceptive needs change. The purpose of this research is to assess changes in condom non-use longitudinally in the context of changes in relationship quality, coital frequency and hormonal contraceptive choice. METHODS:Participants were women (aged 14-17 years at enrollment) recruited from three urban adolescent medicine clinics. Data were collected at three-month intervals using a face-to-face structured interview. Participants were able to contribute up to 10 interviews, but on average contributed 4.2 interviews over the 27-month period. Independent variables assessed partner-specific relationship quality (five items; scale range 5-25; alpha = .92, e.g., this partner is a very important person to me); and, number of coital events with a specific partner. Additional items assessed experience with oral contraceptive pills (OCP) use and injected depo medroxy-progesterone acetate (DMPA). The outcome variable was number of coital events without condom use during the past three months. Analyses were conducted as a three-level hierarchical linear growth curve model using HLM 6. The Level 1 predictor was time, to test the hypothesis that condom non-use increases over time. Level 2 predictors assessed relationship quality and coital frequency across all partners to assess hypotheses that participants' condom non-use increases over time as a function of relationship quality and coital frequency. Level 3 predictors assessed the participant-level influence of OCP or DMPA experience on time-related changes in condom non-use. RESULTS:A total of 176 women reported 279 sex partners and contributed 478 visits. Both average coital frequency and average condom non-use linearly increased during the 27-month follow-up. At any given follow-up, about 35% reported recent OCP use, and 65% reported DMPA use. HLM analyses showed that condom non-use increased as a function of time (beta = .12; p = .03, Level 1 analysis). Increased condom non-use over time was primarily a function of increased coital frequency (beta = .01; p = .00), although higher levels of relationship quality were associated with increased condom non-use at enrollment (beta = .44; p = .00, Level 2 analysis). The temporal rise in condom non-use significantly increased among DMPA users (beta = .06; p = .00) but not OCP users (Level 3 analysis) (beta = -.04; p = .06). CONCLUSIONS:Developmentally, relationship characteristics and coital frequency appear to have increasing weight in decisions about condom use. Hormonal contraceptive methods are not equivalently associated with the overall temporal decline in condom use. Future research associated with dual contraceptive/condom use should address differential factors associated condom use in combination with different hormonal methods.

背景与目标： 目的：持续使用避孕套对于预防青少年性传播感染至关重要，但是随着人际关系和避孕需求的变化，避孕套的使用可能会减少。这项研究的目的是在关系质量，性交频率和激素避孕选择的变化的背景下，纵向评估未使用安全套的变化。
方法：参与者是从三个城市青少年医学诊所招募的女性（入学年龄为14-17岁）。使用面对面的结构化访谈，每三个月收集一次数据。参加者最多可以贡献10个访谈，但在27个月内平均贡献了4.2个访谈。自变量评估了特定于伴侣的关系质量（五个项目；等级范围5-25；α= 0.92，例如，这个伴侣对我来说是非常重要的人）；以及与特定伴侣发生性行为的次数。其他项目评估了口服避孕药（OCP）的使用经验和注射醋酸去甲羟孕酮（DMPA）的经验。结果变量是在过去三个月中未使用安全套的性交事件的数量。使用HLM 6作为三级分层线性增长曲线模型进行了分析。1级预测因子是时间，以检验安全套不使用随时间增加的假设。 2级预测变量评估了所有伴侣之间的关系质量和性交频率，以评估以下假设：参与者不使用安全套会随着时间的推移而增加，这是关系质量和性交频率的函数。 3级预测变量评估了OCP或DMPA经验对安全套不使用时间相关变化的参与者水平影响。
结果：总共176名妇女报告了279个性伴侣，并贡献了478次探视。在27个月的随访中，平均性交频率和平均不使用安全套均呈线性增加。在任何给定的随访中，约35％的患者报告了最近的OCP使用，而65％的患者报告了DMPA的使用。 HLM分析表明，不使用安全套随时间增加（β= .12； p = .03，1级分析）。随着时间的推移，不使用安全套的增加主要是性交频率增加的函数（β= .01； p = .00），尽管较高的关系质量与入学时不使用安全套的增加有关（β= .44； p = .00，第2级分析）。在DMPA用户中，未使用安全套的时间增加显着增加（β= .06； p = .00），但在OCP用户中则没有（水平3分析）（β= -.04； p = .06）。
结论：在发展上，关系特征和性交频率似乎在有关使用安全套的决策中具有越来越大的重要性。激素避孕方法与使用避孕套的总体时间下降没有同等的联系。与双重避孕/避孕套使用相关的未来研究应解决与不同激素方法结合使用避孕套相关的差异因素。

BACKGROUND & AIMS: BACKGROUND AND AIMS:In clonal plants, internode connections allow translocation of photosynthates, water, nutrients and other substances among ramets. Clonal plants form large systems that are likely to experience small-scale spatial heterogeneity. Physiological and morphological responses of Fragaria vesca to small-scale heterogeneity in soil quality were investigated, together with how such heterogeneity influences the placement of ramets. As a result of their own activities plants may modify the suitability of their habitats over time. However, most experiments on habitat selection by clonal plants have not generally considered time as an important variable. In the present study, how the foraging behaviour of clonal plants may change over time was also investigated. METHODS:In a complex of environments with different heterogeneity, plant performance was determined in terms of biomass, ramet production and photosynthetic activity. To identify habitat selection, the number of ramets produced and patch where they rooted were monitored. KEY RESULTS:Parent ramets in heterogeneous environments showed significantly higher maximum and effective quantum yields of photosystem II than parents in homogeneous environments. Parents in heterogeneous environments also showed significantly higher investment in photosynthetic biomass and stolon/total biomass, produced longer stolons, and had higher mean leaf size than parents in homogeneous environments. Total biomass and number of offspring ramets were similar in both environments. However, plants in homogeneous environments showed random allocation of offspring ramets to surrounding patches, whereas plants in heterogeneous environments showed preferential allocation of offspring to higher-quality patches. CONCLUSIONS:The results suggest that F. vesca employs physiological and morphological strategies to enable efficient resource foraging in heterogeneous environments and demonstrate the benefits of physiological integration in terms of photosynthetic efficiency. The findings indicate that short-term responses cannot be directly extrapolated to the longer term principally because preferential colonization of high-quality patches means that these patches eventually show reduced quality. This highlights the importance of considering the time factor in experiments examining responses of clonal plants to heterogeneity.

背景与目标： 背景与目的：在无性植物中，节间连接允许光合产物，水，养分和其他物质在分株间移位。克隆植物形成了可能经历小规模空间异质性的大型系统。研究了草莓（Fragaria vesca）对土壤质量中小尺度异质性的生理和形态响应，以及这种异质性如何影响分株的放置。由于其自身的活动，植物可能会随着时间的流逝而改变其栖息地的适宜性。但是，大多数关于克隆植物选择生境的实验通常没有将时间视为重要变量。在本研究中，还研究了克隆植物的觅食行为如何随时间变化。
方法：在具有不同异质性的复杂环境中，根据生物量，分株产量和光合活性确定植物的生长性能。为了确定生境的选择，监测了分株的数量和它们生根的地方。
关键结果：异质环境中的父母分株显示出光系统II的最大和有效量子产率显着高于同质环境中的父母。与同质环境中的父母相比，异质环境中的父母对光合生物量和茎/总生物量的投资也显着增加，产生的茎更长，平均叶片尺寸也更大。在两种环境中，总生物量和后代分株的数量相似。但是，同质环境中的植物显示后代分株随机分配到周围斑块，而异质环境中的植物显示后代优先分配给更高质量的斑块。
结论：研究结果表明，vesca F. vesca采用生理和形态学策略在异质环境中进行有效的资源觅食，并从光合作用效率方面证明了生理整合的益处。研究结果表明，短期反应不能直接推断到较长期，主要是因为高质量斑块的优先定植意味着这些斑块最终显示出降低的质量。这突出了在检查克隆植物对异质性反应的实验中考虑时间因素的重要性。

BACKGROUND & AIMS: PURPOSE:To determine the clinical importance and relative value of reinterpreting brain CT imaging studies by subspecialty experts regarding changes in clinical management. METHODS:Computerized records were queried at two institutions during the years 2002-2003 for both primary interpretation by board-certified nonneuroradiologists and secondary interpretation by three neuroradiologists. A total of 1,081 cases were reviewed. Each case was initially interpreted as an emergent or urgent study. The reinterpreted studies were scored as concordant or discordant by the subspecialty experts. The discordant studies were then categorized as a "major discordance" if there was a change in clinical management, or as a "minor discordance" if there was no impact or change in clinical management. RESULTS:Of the 1,081 studies reviewed, 14 studies were identified as discordant (1.3%). Of those discordant studies, four were categorized as major discrepancies necessitating a change in clinical management (0.4 %). Ten were categorized as minor discrepancies (0.9%). There were no permanent adverse outcomes with respect to morbidity and mortality as a result of any discrepancy. CONCLUSION:The vast majority of interpreted head CT cases read by board-certified general radiologists do not result in discordant interpretations as verified by subspecialty experts. Discordant interpretations did not result in changes in clinical management in most cases. Double reading of head CTs by subspecialty experts appears to be an inefficient method of substantially improving imaging health quality outcomes.

背景与目标： 目的：确定亚专业专家对临床管理变化进行重新解释脑CT成像研究的临床重要性和相对价值。
方法：在2002年至2003年期间，在两家机构中查询了计算机记录，以获取由董事会认证的非神经放射科医生进行的主要解释，以及由三位神经放射科医生进行的次要解释。总共审查了1,081例。最初，每个案例都被解释为紧急研究。重新解释的研究被专业专家评定为一致或不一致。如果临床管理发生变化，则将不一致的研究分类为“重大不一致”，如果临床管理没有影响或发生变化，则将其分类为“轻微不一致”。
结果：在所审查的1,081项研究中，有14项研究被确定为不一致（1.3％）。在这些不一致的研究中，有四项被归类为需要改变临床管理的主要差异（0.4％）。十个分类为轻微差异（0.9％）。任何差异都不会在发病率和死亡率方面带来永久性的不良后果。
结论：经董事会认证的一般放射科医生阅读的绝大多数解释性头部CT病例，经专科专家验证，并不会导致不一致的解释。在大多数情况下，不一致的解释并不会导致临床管理的改变。专科专家对头颅CT进行双重读取似乎是一种实质上改善影像健康质量结果的无效方法。

BACKGROUND & AIMS: OBJECTIVE:To investigate clinically relevant intra-individual and mean changes in health-related quality of life (HRQoL) with the Short Form-36 Health Survey (SF-36) need to acknowledge that SF-36 is trademarked ie: SF-36(R) following cardiac intervention for Australian and Danish patients. DESIGN:Prospective observational study in tertiary cardiac centres in Townsville, Queensland, Australia and Copenhagen, Denmark. Two hundred coronary artery bypass graft surgery (CABG) patients of two Townsville hospitals, and 47 CABG or percutaneous coronary intervention (PCI) patients of a Copenhagen hospital. The main outcome measures are eight SF-36 health subscales at baseline and six months post-intervention. RESULTS:Australian and Danish patients experienced similar HRQoL pre-intervention. By six months post-intervention, patients experienced a significant mean improvement in all subscales of the SF-36 survey (p < or = 0.05), although up to 27% of patients had a clinically significant decline in HRQoL from baseline. CONCLUSIONS:These results demonstrate that it is necessary to investigate intra-individual changes in HRQoL as well as group mean changes as they produce different conclusions. In addition, establishing clinically significant intra-individual change standards may assist researchers and clinicians in determining whether an individual may benefit from therapy or intervention.

背景与目标： 目的：要通过36型健康调查（SF-36）调查与健康相关的生活质量（HRQoL）的临床相关个体内和平均变化，需要承认SF-36是商标，即：SF-36（ R）对澳大利亚和丹麦患者进行心脏干预后。
设计：在澳大利亚昆士兰州汤斯维尔和丹麦哥本哈根的三级心脏中心进行前瞻性观察研究。两家汤斯维尔医院的200例冠状动脉搭桥术（CABG）患者，以及哥本哈根医院的47例CABG或经皮冠状动脉介入治疗（PCI）患者。主要结果指标是基线时和干预后六个月的八个SF-36健康子量表。
结果：澳大利亚和丹麦患者经历了类似的HRQoL干预前。干预后六个月，患者在SF-36调查的所有子量表中均经历了显着的平均改善（p <或= 0.05），尽管高达27％的患者的HRQoL与基线相比有临床上的显着下降。
结论：这些结果表明，有必要研究HRQoL的个体内部变化以及群体均值变化，因为它们会产生不同的结论。此外，建立具有临床意义的个体内部变更标准可能有助于研究人员和临床医生确定个人是否可以从治疗或干预中受益。

BACKGROUND & AIMS: :The study demonstrates the application of QbD based on historical data for a product at a later development stage - retrospective QbD (rQbD). More specifically, it is investigated the root-cause for the observed slower drug release in Orodispersible Films (ODFs) during storage. Risk assessment tools were used to identify parameters affecting ODFs critical quality attributes, namely percent drug release and residual water content. The parameters room temperature, room relative humidity, drying temperature and mixing equipment were used in the statistical modeling of the available data. The estimated models were then used to define the feasible working region. Statistical modeling indicates that initial residual water content of the ODFs is mainly affected by 2nd order interactions of room temperature, room relative humidity and drying temperature, while the stability of drug release profile is mostly influenced by room temperature and an interaction between room relative humidity and drying temperature. Depending on the drying temperature employed the effect of room temperature and room relative humidity change significantly. This work shows that it is possible to apply rQbD to achieve a greater understanding of the manufacturing process of ODFs and to define a proper design space.

背景与目标： ：研究证明了基于历史数据的QbD在后期产品开发中的应用-回顾性QbD（rQbD）。更具体地说，研究了在储存过程中观察到的较慢的药物在口腔分散膜（ODF）中释放的根本原因。风险评估工具用于确定影响ODF关键质量属性的参数，即药物释放百分比和残留水分。在可用数据的统计模型中，使用了室温，室内相对湿度，干燥温度和混合设备等参数。然后，将估计的模型用于定义可行的工作区域。统计模型表明，ODFs的初始残留水含量主要受室温，室温相对湿度和干燥温度的二阶相互作用影响，而药物释放曲线的稳定性主要受室温以及室温相对湿度与干燥温度之间相互作用的影响。干燥温度。取决于所采用的干燥温度，室温和室内相对湿度的影响会显着变化。这项工作表明，有可能应用rQbD来更好地理解ODF的制造过程并定义适当的设计空间。

BACKGROUND & AIMS: OBJECTIVES:To describe the prevalence of oral diseases and their impact on oral-health-related quality of life in people with severe mental illness undertaking community-based psychiatric care. METHODS:A survey was conducted at eight outpatient psychiatric care clinics in Tower Hamlets, London, UK. One hundred and twelve consecutive patients with mental illness were invited to participate in this study. They were clinically examined and asked to complete the oral health impact profile (OHIP) questionnaire. RESULTS:The response rate was 79% (n = 89); 57 (64%) males and 58 persons over 45 years of age (65%) participated in this survey. Overall OHIP score was 25.4 (95% CI 23.3, 27.4), 70 (78%) were smokers and 45 (51%) had been to the dentist in the last two years. Forty-seven (53%) respondents had caries in at least one tooth, 60 (67%) had 21 teeth and more, and 14 (16%) used dentures. Advanced periodontal treatment was indicated in 42 (55%) of patients and 52.8% (n = 47) patients reported current pain. CONCLUSION:Overall, this survey found that oral health has a great impact on patients with severe mental illness being treated in the community setting and their oral health is poorer than the national adult general population. Future research should consider the causes that relate to the poorer oral health in this population and potential health promotion mechanisms in this population to encourage an upstream approach to health.

背景与目标： 目的：描述接受社区精神病治疗的重度精神疾病患者的口腔疾病患病率及其对口腔健康相关生活质量的影响。
方法：在英国伦敦塔哈姆雷特市的八家门诊精神病诊所进行了一项调查。连续邀请112名精神疾病患者参加这项研究。对他们进行了临床检查，并要求他们填写口腔健康影响概况（OHIP）问卷。
结果：回应率为79％（n = 89）；男性（57％）（64％）和58岁以上的58人（65％）参加了这项调查。 OHIP总体得分为25.4（95％CI 23.3、27.4），吸烟者为70（78％），最近两年去牙医的患者为45（51％）。 47名（53％）的被调查者的至少一颗牙齿上有龋齿； 60（67％）的人有21颗及以上的牙齿，以及14颗（16％）的假牙。 42名（55％）患者表示进行了牙周治疗，目前有疼痛的患者占52.8％（n = 47）。
结论：总体而言，该调查发现，口腔健康对在社区环境中接受治疗的严重精神疾病患者有很大影响，并且其口腔健康比全国成年人口还差。未来的研究应考虑与该人群口腔健康较差的原因以及该人群中潜在的健康促进机制，以鼓励采用上游健康方法。

BACKGROUND & AIMS: :

Background: Despite public education efforts, many people at risk for skin cancer do not practice safe sun behaviors.

Objective: To determine whether machine-based evaluation of UV-induced alterations (VISIA scan) changes self-assessment of facial photoaging, skin cancer risk, and willingness to improve sun protective habits. In addition, to determine whether VISIA scan analysis reveals differences between those with versus without a history of skin cancer, men versus women, those older than 50 versus less than 50 years of age, and Fitzpatrick skin types I-III versus IV-VI.

Methods: Volunteers attending a health expo were recruited and queried about their perceived risk of skin cancer and degree of skin photoaging. All participants underwent facial skin quality analysis of both sides of the face, and then completed a follow-up survey.

Results: Participants' scored self-perceptions of overall skin aging were all statistically significantly worse after VISIA scan analysis. There was no change in perceived skin cancer risk, but most participants expressed intent to improve their sun protection habits.

Limitations: Limitations to this study include selection bias, recall-misclassification bias, and social desirability bias.

Conclusion: Intervention with facial skin analysis can positively affect subjects' stated intent to use sun protection, indicating the importance of appearance in these health decisions.

J Drugs Dermatol. 2017;16(5):453-459.

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背景与目标： ：

背景：尽管进行了公众教育，但许多有皮肤癌风险的人仍未进行安全的日晒行为。

目的：确定是否对紫外线诱发的变化进行基于机器的评估（VISIA扫描）改变面部光老化的自我评估，皮肤癌的风险以及改善防晒习惯的意愿。此外，为了确定VISIA扫描分析是否能揭示出有或没有皮肤癌病史，男性与女性，年龄大于50岁与小于50岁以及Fitzpatrick I-III和IV-VI皮肤类型之间的差异。

方法：招募参加健康博览会的志愿者，并询问他们对皮肤癌的感知风险和皮肤光老化程度。所有参与者都进行了面部两面的面部皮肤质量分析，然后完成了一项后续调查。

结果：在进行VISIA扫描后，参与者对整体皮肤衰老的自我感觉评分在统计学上均显着变差分析。知觉的患皮肤癌风险没有改变，但大多数参与者表示有意改善其防晒习惯。

局限性：本研究的局限性包括选择偏见，召回分类错误和社会可取性偏见。 / p>

结论：进行面部皮肤分析的干预可以正面影响受试者陈述的使用防晒的意图，这表明在这些健康决定中外表的重要性。

J Dermatol。 2017; 16（5）：453-459。 。