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“质量与安全重组”倡议，该倡议旨在将改善和患者安全纳入医疗和护理学校课程。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: BACKGROUND:Pre-injury disability must be determined when assessing whether treatment programs return people to pre-injury status, however there is little empirical evidence to support recommendations that this be done as soon as possible after injury to prevent recall bias. OBJECTIVES:To determine disagreement between recall of pre-injury disability at different time points post-injury and bias towards under- or overestimating pre-injury disability. METHODS:Self-reported pre-injury global disability was assessed within days, 6 months and 12 months post-injury in patients admitted to two level 1 adult trauma centres. Kappa statistics and multiple logistic regression models identified predictors of disagreement between time-points. RESULTS:Pre-injury disability was measured at all time-points in 801 patients. Pre-injury disability at baseline was rated as none, mild, moderate, marked and severe in 80%, 12%, 5.1%, 1.9% and 1.0% respectively. Absolute agreement between baseline and 6 and 12 months respectively, was 79% and 80%. Corresponding kappa values (95% confidence intervals) were 0.33 (0.26-0.40) and 0.32 (0-25-0.38). Patients over 65 years or not completing high school were more likely to report less pre-injury disability at 6 and 12 months than at baseline with adjusted odds ratios (95% confidence intervals) for these groups being 8.24 (4.32-15.72) and 1.93 (1.03-3.64) respectively. CONCLUSIONS:There was little evidence of recall bias in an adult trauma population if self-reported global pre-injury disability was assessed 6 months post-injury. The recall of pre-injury disability up to 6 months post-injury can be used to determine return to pre-injury status, if assessment is not feasible shortly after injury.

背景与目标： 背景：在评估治疗方案是否使人们恢复到损伤前的状态时必须确定损伤前的残疾，但是很少有经验证据支持建议在受伤后尽快进行以防止回忆偏倚。
目的：确定在受伤后不同时间召回受伤前残疾与偏低或高估受伤前残疾之间的分歧。
方法：在两个一级成人创伤中心收治的患者，在受伤后几天，六个月和十二个月内对自我报告的损伤前总体残疾进行了评估。 Kapp统计和多个Logistic回归模型确定了时间点之间分歧的预测因素。
结果：在所有时间点对801名患者进行了损伤前残疾测量。基线时的伤前残疾分别为无，轻，中，显着和严重，分别为80％，12％，5.1％，1.9％和1.0％。基线与6个月和12个月之间的绝对一致性分别为79％和80％。相应的kappa值（95％置信区间）为0.33（0.26-0.40）和0.32（0-25-0.38）。 65岁以上或未完成高中阶段的患者在6和12个月时报告的受伤前残疾可能性要比基线时低，这些人群的校正比值比（95％置信区间）为8.24（4.32-15.72）和1.93（ 1.03-3.64）。
结论：如果在伤后6个月进行自我报告的全球损伤前残疾评估，则几乎没有证据表明成年人创伤人群的回忆偏倚。如果在受伤后不久无法进行评估，则可以使用召回至受伤后6个月的受伤前残疾来确定是否恢复到受伤前状态。

BACKGROUND & AIMS: BACKGROUND:Outcome in stroke trials is often based on a 3-month modified Rankin scale (mRS). How 3-month mRS relates to longer-term outcomes will depend on late recovery, delayed stroke-related deaths, recurrent strokes, and nonstroke deaths. We evaluated 3-month mRS and death/disability at 1 and 5 years in a population-based cohort study. METHODS AND RESULTS:In 3-month survivors of ischemic stroke (Oxford Vascular Study; 2002-2014), we related 3-month mRS to disability (defined as mRS >2) at 1 and 5 years and/or death rates (age/sex adjusted). Accrual of disability and index-stroke-related and nonstroke deaths in each poststroke year was categorized according to 3-month mRS. Among 1606 patients with acute ischemic stroke, 181 died within 3 months, but 126 index-stroke-related deaths and 320 other deaths occurred during the subsequent 4866 patient-years of follow-up up to 5 years. Although 69/126 (54.8%) post-3-month index-stroke-related deaths occurred after 1 year, mRS>2 at 1 year strongly predicted these deaths (adjusted hazard ratio=21.94, 95%CI 7.88-61.09, P<0.0001). Consequently, a 3-month mRS >2 was a strong independent predictor of death at both 1 year (adjusted hazard ratio=6.67, 95%CI 4.16-10.69, P<0.0001) and 5 years (adjusted hazard ratio=2.93, 95%CI 2.38-3.60, P<0.0001). Although mRS improved by ≥1 point from 3 months to 1 year in 317/1266 (25.0%) patients with 3-month mRS ≥1, improvement in mRS after 1 year was limited (improvement by ≥1 point: 91/858 [10.6%]; improvement to mRS ≤2: 13/353 [3.7%]). CONCLUSIONS:Our results reaffirm use of the 3-month mRS outcome in stroke trials. Although later recovery does occur, extending follow-up to 1 year would capture most long-term stroke-related disability. However, administrative mortality follow-up beyond 1 year has the potential to demonstrate translation of early disability gains into additional reductions in long-term mortality without much erosion by non-stroke-related deaths.

背景与目标： 背景：中风试验的结果通常基于3个月的改良兰金量表（mRS）。 3个月的mRS与长期结果的关系将取决于晚期康复，中风相关的延迟死亡，中风复发和非中风死亡。在一项基于人群的队列研究中，我们评估了3个月的mRS和1年和5年时的死亡/残疾。
方法和结果：在3个月的缺血性卒中幸存者中（牛津血管研究; 2002-2014年），我们将3个月的mRS与1岁和5岁时的残疾（定义为mRS> 2）和/或死亡率（年龄/性别调整）。根据每个月的3个月mRS对残疾的累积以及与卒中相关的卒中和非卒中死亡进行分类。在1606例急性缺血性中风患者中，有3个月内有181例死亡，但在随后的4866个患者年的随访中（长达5年）发生了126例与中风相关的死亡，还有320例其他死亡。尽管1年后发生69/126（54.8％）的3个月后与指数卒中相关的死亡，但1年时的mRS> 2强烈预测了这些死亡（调整后的危险比= 21.94，95％CI 7.88-61.09，P < 0.0001）。因此，在1年（调整后的危险比= 6.67，95％CI 4.16-10.69，P <0.0001）和5年（调整后的危险比= 2.93，95％）下，三个月的mRS> 2是死亡的强有力的独立预测因子。 CI 2.38-3.60，P <0.0001）。尽管317/1266（35.0％）3个月mRS≥1的患者在3个月至1年间mRS改善了≥1点，但1年后mRS的改善是有限的（≥1点的改善：91/858 [10.6 ％]； mRS≤2的改善：13/353 [3.7％]）。
结论：我们的研究结果重申了在卒中试验中使用3个月的mRS结果。尽管确实会出现稍后的康复，但将随访延长至1年将捕获大多数与中风相关的长期残疾。但是，对1年以上的行政死亡率进行随访，有可能证明将早期残疾的增加转化为长期死亡率的进一步降低，而不会因非中风相关的死亡而受到很大的侵蚀。

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，半球，尤其是脑室病变）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: :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叙述，对个人访谈和数据进行主题分析。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过程如何增强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: :The objective indicators which reflect the past results of end-stage knee osteoarthritis (OA) patients who have already received total knee arthroplasty (TKA) could be helpful for physicians to discuss with patients who are considering TKA. The aim of this prospective cohort study was to examine whether we could predict the knee OA patients who would receive TKA in advance based on baseline data, and to set cut-off points for receiving TKA. The two-hundred and forty end-stage medial-type knee OA patients were enrolled and followed up for 6 months while performing therapeutic exercises. Radiographic findings, visual analog scale for pain and a patient-oriented outcome measure, the Japanese Knee Osteoarthritis Measure (JKOM), were recorded at baseline. Relative risks (RRs) using the area under the curve (AUC) for a receiver operating characteristic (ROC) curve were calculated to evaluate several scores for receiving TKA. While 119 patients (55.3 %) did not undergo TKA, the remaining 96 patients (44.7 %) underwent TKA during this period. The AUCs of the ROC curve for the JKOM total score [0.71 (95 % CI 0.64-0.79)] were higher than those for radiographic parameters. Among the JKOM subcategories, JKOM category III, which indicates the condition in daily life, showed the highest AUC of 0.72 (0.65-0.80). The JKOM total score (65/100) and JKOM category III score (17/40) showed RRs of 2.20 (1.33-3.63) and 1.95 (1.18-3.22) for receiving TKA, respectively. The presence of disability in daily living was found to be an important factor determining whether the patient should undergo TKA.

背景与目标： ：客观的指标反映了已经接受全膝关节置换术（TKA）的晚期膝关节骨关节炎（OA）患者的过去结果，可能有助于医生与正在考虑进行TKA的患者进行讨论。这项前瞻性队列研究的目的是检查我们是否可以根据基线数据预测可以提前接受TKA的膝骨OA患者，并设定接受TKA的临界点。入选了240例中晚期膝关节OA患者，并进行了6个月的随访，同时进行了治疗性锻炼。在基线记录影像学发现，疼痛的视觉模拟量表和以患者为导向的结果指标，即日本膝骨关节炎指标（JKOM）。使用接收者操作特征（ROC）曲线的曲线下面积（AUC）计算相对风险（RRs），以评估接收TKA的几个分数。虽然有119名患者（55.3％）没有接受过TKA，但其余96名患者（44.7％）在此期间接受了TKA。 JKOM总分[0.71（95％CI 0.64-0.79）]的ROC曲线的AUC高于射线照相参数的AUC。在JKOM子类别中，指示日常生活状况的JKOM第三类显示最高的AUC为0.72（0.65-0.80）。 JKOM总评分（65/100）和JKOM III类评分（17/40）分别显示，接受TKA的RR为2.20（1.33-3.63）和1.95（1.18-3.22）。发现日常生活中是否存在残疾是决定患者是否应该接受TKA的重要因素。

BACKGROUND & AIMS: PURPOSE:Few individuals with spinal cord injury (SCI) engage in the recommended amount of leisure time physical activity (LTPA). Yet little is known about how, and why, active individuals engage in specific types of LTPA. This study explored how a unique narrative environment and disability narratives motivated individuals with SCI to engage in LTPA. METHOD:Fourteen individuals with SCI from a physical activity program participated in approximately hour-long interviews. Interviews were then subjected to a narrative analysis. RESULTS:Individuals who used a restitution narrative (n = 6) were motivated to engage in functional LTPA because of the desire to maintain the body and restore the past self. The individual who used the chaos narrative (n = 1) preferred solitary LTPA as exposure to others with SCI was a constant reminder of the lost, pre-injury self. Individuals who used a quest narrative (n = 7) explored LTPA options that fit with their interests; these individuals were open to new types of LTPA, such as sport and outdoor recreation. CONCLUSION:The plot of three disability narratives can all motivate the pursuit of LTPA; however, not all types of LTPA are seen as equal. LTPA interventions can be enhanced through the lessons learned from this unique type of environment. IMPLICATIONS FOR REHABILITATION:Despite individuals' views about their disability, they can still be motivated to engage in routine LTPA. Different theoretical determinants, such as health or social benefits, hold different relevance for LTPA among individuals with differing disability narratives. The environment provided by practitioners can therefore elicit some stories of SCI while stifling others. Open narrative environment will attract individuals to listen and maintain involvement in LTPA.

背景与目标： 目的：很少有脊髓损伤（SCI）的人从事建议量的休闲时间体育锻炼（LTPA）。对于活动个体如何以及为什么参与特定类型的LTPA知之甚少。这项研究探讨了独特的叙事环境和残疾叙事如何激励SCI个人参与LTPA。
方法：来自体育锻炼计划的十四名患有SCI的人参加了大约一个小时的访谈。然后对访谈进行叙事分析。
结果：使用恢复性叙述的个体（n = 6）被激发从事功能性LTPA的动机，因为他们渴望维持身体并恢复过去的自我。使用混乱叙事（n = 1）的人更喜欢孤独的LTPA，因为他们接触SCI的人不断提醒自己迷失，受伤前的自我。使用任务叙述（n = 7）的个人探索了符合他们兴趣的LTPA选项；这些人愿意接受新的LTPA类型，例如运动和户外休闲。
结论：三种残疾叙述的情节都可以激发人们对LTPA的追求。但是，并非所有类型的LTPA都被认为是平等的。通过从这种独特类型的环境中学到的经验教训，可以增强LTPA干预措施。
康复的意义：尽管个人对他们的残疾有不同的看法，但他们仍然可以被激励去参加常规的LTPA。在具有不同残疾陈述的个人中，不同的理论决定因素（例如健康或社会福利）与LTPA的相关性不同。因此，从业人员提供的环境可以引发一些SCI故事，同时又扼杀其他故事。开放的叙事环境将吸引个人倾听并保持对LTPA的参与。

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。患者和对照者做出相似的动作，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: OBJECTIVE:The objective of this study was to identify clinical and social predictors of application for Social Security Disability Insurance (SSDI) in workers' compensation claimants with low back pain. METHODS:Archival and interview data were analyzed for 1372 Missouri claimants who were, on average, nearly 42 months postinjury. RESULTS:Two hundred sixty-five (19.3%) claimants were receiving SSDI (8.0%) or had applied for SSDI (11.3%). Logistic regression indicated that black race, older age, herniated disc diagnosis, surgery, and longer time since injury were associated with increased odds of SSDI. Higher preinjury wage, more education, and higher satisfaction with medical treatment and/or treatment by employer were associated with decreased odds of SSDI. CONCLUSIONS:Application for SSDI among claimants with occupational low back pain is associated with social factors like race, satisfaction, and socioeconomics as well as clinical factors like diagnosis and surgery.

背景与目标： 目的：本研究的目的是确定在腰背痛的工伤索赔人中申请社会保障残疾保险的临床和社会预测指标。
方法：分析了密苏里州1372名索赔人的档案和访谈数据，他们平均受伤后将近42个月。
结果：265名（19.3％）索赔人正在接受SSDI（8.0％）或已申请SSDI（11.3％）。 Logistic回归表明，黑人种族，年龄较大，椎间盘突出症，手术以及自受伤以来的较长时间与SSDI几率增加相关。更高的伤害前工资，更多的教育以及对医疗和/或雇主待遇的更高满意度与降低SSDI的几率相关。
结论：在职业性下腰痛的索赔人中申请SSDI与种族，满意度和社会经济学等社会因素以及诊断和手术等临床因素有关。

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: 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）当使用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WSD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: :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。