• 【抗菌药物的使用和肺炎链球菌青霉素耐药性:时间关系模型。】 复制标题 收藏 收藏
    DOI:10.1089/mdr.2006.12.158 复制DOI
    作者列表:Mera RM,Miller LA,White A
    BACKGROUND & AIMS: :The nature of the temporal relationship between antibacterial consumption and Streptococcus pneumoniae penicillin resistance is investigated using population level data across time. IMS Health Global Services provided national outpatient antibiotic prescription data for the years 1996-2003 from France, Spain, Italy, Germany, the United Kingdom, and the United States. Surveillance data consist of S. pneumoniae isolates obtained from a surveillance database in the same geographic regions from 1996 to 2003. A linear mixed model for repeated measures was used to analyze the association between resistance and several antibacterial classes through time. Changes in penicillin resistance through time in any country are better explained by the weighted cumulative antibacterial consumption with a 2-year lag. Narrow-spectrum penicillins are associated with lower resistance rates. Large reductions in consumption at the population level are needed to affect resistance. There is a peak level of penicillin resistance associated with cumulative exposure to a combination of antibiotic classes that is unique for every country.
    背景与目标: :使用跨时间的人口水平数据调查了抗菌药物消费与肺炎链球菌青霉素耐药性之间时间关系的性质。 IMS Health Global Services提供了1996-2003年法国,西班牙,意大利,德国,英国和美国的国家门诊抗生素处方数据。监测数据由1996年至2003年从同一地理区域的监测数据库中获得的肺炎链球菌分离株组成。采用线性混合模型进行重复测量,以分析耐药性与一段时间内几种抗菌剂类别之间的关联。在任何国家,青霉素耐药性随时间的变化都可以通过加权累积抗菌药消费量(滞后2年)来更好地说明。窄谱青霉素与较低的耐药率有关。需要在人口一级大幅度减少消费量以影响抵抗力。青霉素耐药性的峰值与每个国家所独有的抗生素类药物的累积接触有关。
  • 【皮层听觉诱发电位的使用来评估成人语音的神经编码。】 复制标题 收藏 收藏
    DOI:10.3766/jaaa.17.8.3 复制DOI
    作者列表:Agung K,Purdy SC,McMahon CM,Newall P
    BACKGROUND & AIMS: :There has been considerable recent interest in the use of cortical auditory evoked potentials (CAEPs) as an electrophysiological measure of human speech encoding in individuals with normal as well as impaired auditory systems. The development of such electrophysiological measures such as CAEPs is important because they can be used to evaluate the benefits of hearing aids and cochlear implants in infants, young children, and adults that cannot cooperate for behavioral speech discrimination testing. The current study determined whether CAEPs produced by seven different speech sounds, which together cover a broad range of frequencies across the speech spectrum, could be differentiated from each other based on response latency and amplitude measures. CAEPs were recorded from ten adults with normal hearing in response to speech stimuli presented at a conversational level (65 dB SPL) via a loudspeaker. Cortical responses were reliably elicited by each of the speech sounds in all participants. CAEPs produced by speech sounds dominated by high-frequency energy were significantly different in amplitude from CAEPs produced by sounds dominated by lower-frequency energy. Significant effects of stimulus duration were also observed, with shorter duration stimuli producing larger amplitudes and earlier latencies than longer duration stimuli. This research demonstrates that CAEPs can be reliably evoked by sounds that encompass the entire speech frequency range. Further, CAEP latencies and amplitudes may provide an objective indication that spectrally different speech sounds are encoded differently at the cortical level.
    背景与目标: :最近,人们对使用皮质听觉诱发电位(CAEP)作为正常和听觉系统受损的人的语音编码的电生理学方法感兴趣。诸如CAEPs之类的电生理指标的发展非常重要,因为它们可用于评估助听器和人工耳蜗在无法配合行为语音辨别力测试的婴儿,幼儿和成人中的益处。当前的研究确定了是否可以根据响应潜伏期和幅度度量来区分由七种不同的语音产生的CAEP,这些CAEP涵盖整个语音频谱的广泛频率范围。记录了十名成年人的CAEPs,这些成年人是通过扬声器以对话级别(65 dB SPL)呈现的语音刺激而正常听力的。在所有参与者中,每种语音都可靠地引起了皮层反应。由高频能量支配的语音产生的CAEP与由低频能量支配的声音产生的CAEP在幅度上有显着差异。还观察到了刺激持续时间的显着效果,持续时间较短的刺激比持续时间较长的刺激产生更大的振幅和更短的等待时间。这项研究表明,包含整个语音频率范围的声音可以可靠地诱发CAEP。进一步地,CAEP等待时间和幅度可以提供客观的指示,即频谱不同的语音在皮质水平上被不同地编码。
  • 【关节内高分子量透明质酸注射液治疗颞下颌关节的非复位性椎间盘移位的短期治疗效果。】 复制标题 收藏 收藏
    DOI:10.1016/j.tripleo.2005.09.018 复制DOI
    作者列表:Yeung RW,Chow RL,Samman N,Chiu K
    BACKGROUND & AIMS: :In a patient with temporomandibular disorder who does not respond to conservative treatment, treatment with intra-articular injection of high molecular weight sodium hyaluronate can be suggested. In our study, 27 patients with nonreduced disc displacement were diagnosed clinically and confirmed by magnetic resonance imaging. The age range was from 21 to 63 years old, with a mean of 39.3 years. Two cycles of injection of high molecular weight sodium hyaluronate was performed on alternative weeks. Pain intensity was measured by the visual analog scale. Maximal mouth opening, clicking joint noise, and lateral movement were measured before and after injection for more than 6 months. Reduction of pain intensity and improvement in the maximum mouth opening parameter was statistically significant. In conclusion, this intra-articular injection using high molecular weight sodium hyaluronate looks very positive for patients affected by nonreduced disc displacement and is encouraged to be used as a primary treatment of temporomandibular joint dysfunction.
    背景与目标: :对于颞下颌关节疾病,对保守治疗无反应的患者,建议采用关节内注射高分子量透明质酸钠进行治疗。在我们的研究中,临床上诊断出27例椎间盘移位未减少的患者,并通过磁共振成像对其进行了确认。年龄范围是21至63岁,平均39.3岁。每隔几个星期进行两次高分子量透明质酸钠注射。通过视觉模拟量表测量疼痛强度。在注射前后超过6个月,测量了最大张口,咔嗒声和侧向运动。疼痛强度的降低和最大张口参数的改善在统计学上是显着的。总之,这种高分子量透明质酸钠的关节腔内注射对于未减少椎间盘移位的患者看起来非常积极,因此被鼓励用作颞下颌关节功能障碍的主要治疗方法。
  • 【意大利北部某地区的综合废物管理:堆肥的生产和使用,以及堆肥,土壤和农作物的分析控制。】 复制标题 收藏 收藏
    DOI:10.1080/03601230600857031 复制DOI
    作者列表:Guerini G,Maffeis P,Allievi L,Gigliotti C
    BACKGROUND & AIMS: :Agricultural soils of two Italian maize farms were treated for five years with an industrially produced high-quality compost. Cattle manure and the usual mineral fertilizer were used for comparison purposes. The effects of the organic and mineral fertilizer treatments were studied by analyzing the compost and manure, cultured soils, and harvested material. The grain yield was also determined. Organic fertilization improved soil pH, CEC, content of organic matter and NPK. Soil respiration and N mineralization were found to be higher than in the purely mineral-treated soil. Plant K take-up was improved, whereas grain yield was not affected. It was confirmed that organic fertilization, particularly compost use, maintained and increased soil fertility. The study demonstrated the feasibility of using in loco analytical facilities to follow the entire recycling process-from waste to compost production-and the use of the final product in the field.
    背景与目标: :意大利的两个玉米农场的农业土壤用工业生产的高质量堆肥处理了五年。为了比较,使用了牛粪和通常的矿物肥料。通过分析堆肥和肥料,耕种的土壤和收获的物料,研究了有机肥料和矿物肥料的处理效果。还确定了谷物产量。有机肥改善了土壤的pH,CEC,有机质含量和NPK。发现土壤呼吸和氮矿化比纯矿物处理过的土壤要高。钾素吸收量得到改善,而谷物单产却没有受到影响。可以肯定的是,有机肥,特别是堆肥的使用,保持并增加了土壤肥力。该研究证明了在机车分析设施中使用该方法以跟踪整个回收过程的可行性(从废物到堆肥的生产)以及最终产品在野外的使用。
  • 【注意缺陷多动障碍可能与中枢性脑源性神经营养因子活性降低有关:临床和治疗意义。】 复制标题 收藏 收藏
    DOI:10.1016/j.mehy.2006.06.025 复制DOI
    作者列表:Tsai SJ
    BACKGROUND & AIMS: :Attention-deficit hyperactivity disorder (ADHD) is a common childhood psychiatric disorder. Despite intensive research efforts, the aetiology of ADHD remains unknown. Current evidence suggests that the aetiology of ADHD is heterogeneous, comprising of multiple factors. Recently, it has been proposed that brain-derived neurotrophic factor (BDNF), a member of the neurotrophic factor family, may be implicated in the pathogenesis of ADHD. This hypothesis is supported by recent genetic studies in ADHD. Drawing on findings from studies into the drugs for ADHD relating to central BDNF expression, hyperactivity in BDNF knockout mice, BDNF effects in midbrain dopaminergic function and the close association between BDNF and the dopamine transporter (an important molecule for ADHD pathogenesis), it is proposed here that decreased central BDNF, particularly in the midbrain region, may play an important role in the pathogenesis ADHD. This hypothesis may have some implications for clinical findings in ADHD (for example, the co-morbidity between ADHD and major depression), and provide a new direction for the development of medication for ADHD treatment.
    背景与目标: 注意缺陷多动障碍(ADHD)是儿童期常见的精神病。尽管进行了深入的研究,但多动症的病因仍然未知。当前证据表明,ADHD的病因是异质的,由多种因素组成。最近,已经提出,脑源性神经营养因子(BDNF),神经营养因子家族的成员,可能与ADHD的发病有关。这一假说得到了多动症最近的遗传学研究的支持。根据对ADHD药物的研究发现,该药物与中枢BDNF表达,BDNF基因敲除小鼠的过度活跃,BDNF对中脑多巴胺能功能的影响以及BDNF与多巴胺转运蛋白(ADHD发病机理的重要分子)之间的紧密联系有关,因此提出了这一建议。在这里,中央BDNF的降低,特别是在中脑区域,可能在ADHD的发病中起重要作用。该假设可能对ADHD的临床发现有一定的影响(例如,ADHD与严重抑郁症的合并症),并为ADHD治疗药物的开发提供了新的方向。
  • 【青春期妇女之间的关系质量,激素避孕选择和不使用避孕套的发展联系。】 复制标题 收藏 收藏
    DOI:10.1016/j.jadohealth.2005.12.027 复制DOI
    作者列表:Sayegh MA,Fortenberry JD,Shew M,Orr DP
    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)。随着时间的流逝,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相关(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(第三级分析)(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。
  • 【在心肌梗死后和心力衰竭患者中使用缬沙坦。】 复制标题 收藏 收藏
    DOI:10.3317/jraas.2006.019 复制DOI
    作者列表:Liu PP,Maggioni A,Velazquez EJ
    BACKGROUND & AIMS: :Left ventricular (LV) dysfunction and/or heart failure (HF) are frequent complications of hypertension and myocardial infarction (MI), placing affected patients at increased risk of significant morbidity and premature death. Given that the renin-angiotensin-aldosterone system (RAAS) is activated and of pathophysiological importance in such patients, a strong therapeutic rationale exists to target the main effector mechanism (that is, angiotensin II [Ang II]) in order to lessen the associated morbidity and mortality burden. Angiotensin-converting enzyme (ACE) inhibitors have been shown to reduce mortality and LV dysfunction and to slow disease progression in patients with HF, including high-risk, post-MI patients. However, ACE inhibitors (ACE-Is) may not provide optimal long-term RAAS blockade (a finding that is associated with a worse prognosis) and many patients are unable to tolerate such therapy (because of troublesome dry cough, for example). In contrast, Ang II receptor blockers (ARBs) may block the RAAS more completely than ACE-Is and appear to be better tolerated. Several large-scale trials gave evaluated the efficacy of ARBs in patients with LV dysfunction and/or HF (including high-risk, post-MI patients), and have confirmed their utility as an efficacious and well-tolerated alternative to ACE-Is in this setting.
    背景与目标: :左心室(LV)功能障碍和/或心力衰竭(HF)是高血压和心肌梗塞(MI)的常见并发症,使受影响的患者罹患显着发病率和过早死亡的风险增加。鉴于肾素-血管紧张素-醛固酮系统(RAAS)已被激活并且在此类患者中具有重要的病理生理意义,因此存在针对主要效应机制(即血管紧张素II [Ang II])的强大治疗原理,以减轻相关的疾病。发病率和死亡率负担。血管紧张素转换酶(ACE)抑制剂已被证明可以降低HF患者(包括高危MI后患者)的死亡率和LV功能障碍,并减缓疾病进展。但是,ACEI(ACE-Is)可能无法提供最佳的长期RAAS阻断作用(这一发现与更坏的预后相关),并且许多患者无法忍受此类治疗(例如,由于干咳引起的麻烦)。相比之下,Ang II受体阻滞剂(ARBs)可能比ACE-Is更完全地阻断RAAS,并且似乎具有更好的耐受性。几项大规模试验评估了ARB在LV功能不全和/或HF患者(包括高风险,MI后患者)中的疗效,并证实了其作为ACE-Is的有效且耐受性良好的替代品的用途。此设置。
  • 【腺病毒VAI小RNA用作核酶细胞质传递的载体。】 复制标题 收藏 收藏
    影响因子 :
    发表时间:1997-06-01
    来源期刊:RNA
    DOI: 复制DOI
    作者列表:Prislei S,Buonomo SB,Michienzi A,Bozzoni I
    BACKGROUND & AIMS: The in vivo effectiveness of therapeutic RNAs, like antisense molecules and ribozymes, relies on several featuresRNA molecules need to be expressed at high levels in the correct cellular compartment as stable and active molecules. The exploitation of "natural" small RNA coding genes as expressing cassettes gives high chances to fulfill these requirements. We have investigated the utilization of the adenoviral VAI RNA as a cytoplasmatic carrier for expressing ribozymes against HIV-1. The conserved 5' leader sequence of HIV was chosen as a target, because it is present in all the viral transcripts and is highly conserved. Hammerhead ribozymes were substituted to different portions of the VAI RNA and the resulting chimera were tested in the in vivo system of Xenopus laevis oocytes for their level of accumulation, cellular compartmentalization, and assembly in specific ribonucleoparticles containing the La antigen. Interesting differences in the activity of the different chimera were found in both in vitro cleavage assays and S100 extracts of injected oocytes where the catalytic activity of the ribozymes in the RNP context can be analyzed.

    背景与目标: 像反义分子和核酶一样,治疗性RNA的体内有效性取决于几个特征。RNA分子需要在正确的细胞室内高水平表达为稳定和活跃的分子。利用“天然”小RNA编码基因作为表达盒可以满足这些要求。我们已经研究了腺病毒VAI RNA作为表达HIV-1核酶的细胞质载体的利用。选择了保守的HIV 5'前导序列作为靶标,因为它存在于所有病毒转录物中并且是高度保守的。将锤头状核酶替换为VAI RNA的不同部分,并在非洲爪蟾卵母细胞的体内系统中测试了所得嵌合体的积累水平,细胞区室化和在包含La抗原的特定核糖核酸颗粒中的组装。在体外卵裂分析和注射卵母细胞的S100提取物中都发现了不同嵌合体活性的有趣差异,其中可以分析核酶在RNP环境中的催化活性。

  • 【马铃薯(Solanum tuberosum L.)对部分根区干燥的生理响应:ABA信号传递,叶片气体交换和水分利用效率。】 复制标题 收藏 收藏
    DOI:10.1093/jxb/erl131 复制DOI
    作者列表:Liu F,Shahnazari A,Andersen MN,Jacobsen SE,Jensen CR
    BACKGROUND & AIMS: :The physiological responses of potato (Solanum tuberosum L. cv. Folva) to partial root-zone drying (PRD) were investigated in potted plants in a greenhouse (GH) and in plants grown in the field under an automatic rain-out-shelter. In the GH, irrigation was applied daily to the whole root system (FI), or to one-half of the root system while the other half was dried, for 9 d. In the field, the plants were drip irrigated either to the whole root system near field capacity (FI) or using 70% water of FI to one side of the roots, and shifted to the other side every 5-10 d (PRD). PRD plants had a similar midday leaf water potential to that of FI, whereas in the GH their root water potential (Psi(r)) was significantly lowered after 5 d. Stomatal conductance (g(s)) was more sensitive to PRD than photosynthesis (A) particularly in the field, leading to greater intrinsic water use efficiency (WUE) (i.e. A/g(s)) in PRD than in FI plants on several days. In PRD, the xylem sap abscisic acid concentration ([ABA](xylem)) increased exponentially with decreasing Psi(r); and the relative [ABA](xylem) (PRD/FI) increased exponentially as the fraction of transpirable soil water (FTSW) in the drying side decreased. In the field, the leaf area index was slightly less in PRD than in FI treatment, while tuber biomass was similar for the two treatments. Compared with FI, PRD treatment saved 30% water and increased crop water use efficiency (WUE) by 59%. Restrictions on leaf area expansion and g(s) by PRD-induced ABA signals might have contributed to reduced water use and increased WUE.
    背景与目标: :在温室(GH)的盆栽植物和自动防雨棚田间种植的植物中,研究了马铃薯(Solanum tuberosum L. cv。Folva)对部分根区干燥(PRD)的生理响应。在GH中,每天对整个根系(FI)或一半的根系进行灌溉,而另一半干燥9 d。在田间,将植物滴灌至接近田间持水量(FI)的整个根系,或使用70%的FI水将其滴到根的一侧,然后每5-10 d(PRD)移至另一侧。珠三角植物的中午叶片水势与FI相似,而在GH中,其根系水势(Psi(r))在5天后显着降低。尤其是在田间,气孔电导(g(s))比光合作用(A)对PRD更敏感,因此在几个地方,PRD中的固有水分利用效率(WUE)(即A / g(s))比FI植物更大。天。在珠三角地区,木质部汁液中脱落酸的浓度([ABA](木质部))随着Psi(r)的降低呈指数增长。相对[ABA](木质部)(PRD / FI)随干旱侧可蒸发土壤水(FTSW)比例的减少呈指数增长。在田间,珠三角的叶面积指数略低于FI处理,而两种处理的块茎生物量相似。与FI相比,PRD处理节省了30%的水,并使作物水分利用效率(WUE)提高了59%。 PRD诱导的ABA信号对叶面积扩大和g(s)的限制可能有助于减少用水量和增加WUE。
  • 【将集中开发的药物经济学评估用于当地配方决策。】 复制标题 收藏 收藏
    DOI:10.2146/ajhp060027 复制DOI
    作者列表:Tordoff JM,Murphy JE,Norris PT,Reith DM
    BACKGROUND & AIMS: PURPOSE:The distribution, content, timeliness, use, and influence of pharmacoeconomic assessments (PEAs) of drugs in New Zealand public hospitals were examined. METHODS:In April 2005, a questionnaire-based, cross-sectional survey was sent to chief pharmacists at all 29 New Zealand hospitals employing a pharmacist. The questionnaire asked pharmacists about the use and influence of PEAs in their hospitals' formulary decision-making process. Answers were given using a scale of 1 to 6, with 1 being the most positive response. RESULTS:Of the 29 surveys mailed, 24 (83%) were completed. Data on 12 PEAs were analyzed. Assessments were seen and summaries read in most hospitals (median, 77% and 65%, respectively). Full documents were read in fewer hospitals (35%). In general, the PEAs were considered moderately easy to understand, provided a concise summary, and contained adequate detail of the methodology. Of the 24 respondent hospitals, 21 had assessment processes for new medicines; hence, a total of 252 hospital evaluations of Pharmaceutical Management Agency (PHARMAC)-assessed drugs were possible. A total of 132 possible evaluations (52%) were undertaken. More evaluations (106 [42%]) took place before PHARMAC's PEAs were distributed and fewer (26 [10%]) after distribution. Where used, the PEAs appeared to have a modest effect on hospital decisions. CONCLUSION:The provision of 12 PEAS by PHARMAC to hospitals in New Zealand had only a modest influence on their formulary decision-making process, mostly due to the lack of timeliness of the PEAs. The timely delivery of centrally developed PEAs may be essential to generating a greater effect on the formulary decisions at a wider level.
    背景与目标: 目的:检查了新西兰公立医院药物的药物经济评估(PEA)的分布,内容,及时性,使用和影响。
    方法:2005年4月,基于问卷调查的横断面调查被发送给新西兰所有29家雇用药剂师的医院的首席药剂师。该问卷向药剂师询问了PEA在其医院处方制定决策过程中的使用和影响。答案以1到6的等级给出,其中1是最积极的回答。
    结果:在邮寄的29份调查中,有24份(83%)已完成。分析了12个PEA的数据。大多数医院都进行了评估并阅读了摘要(中位数分别为77%和65%)。较少的医院(35%)读取了完整的文档。一般而言,PEA被认为具有中等程度的易懂性,提供了简洁的摘要,并包含了该方法的足够详细信息。在24家受访医院中,有21家拥有新药评估程序;因此,总共可以对252个由美国药物管理局(PHARMAC)评估的药物进行医院评估。总共进行了132次可能的评估(52%)。在分发PHARMAC的PEA之前进行了更多的评估(106 [42%]),而在分发之后进行的评估较少(26 [10%])。在使用PEA的情况下,似乎对医院的决策影响不大。
    结论:PHARMAC向新西兰的医院提供了12个PEAS,对他们的处方制定决策过程影响不大,这主要是由于PEAs缺乏及时性。及时提供集中开发的PEA对于在更大范围内对配方决策产生更大影响可能是必不可少的。
  • 【青少年青少年物质使用的升级和开始:同龄人使用感知的影响。】 复制标题 收藏 收藏
    DOI:10.1016/j.jadohealth.2006.02.010 复制DOI
    作者列表:D'Amico EJ,McCarthy DM
    BACKGROUND & AIMS: PURPOSE:The middle school years are peak years for substance use initiation. The current study assessed the impact of peer influence on both initiation and escalation of cigarette, alcohol, and marijuana use among sixth, seventh, and eighth graders. METHODS:Youth (n = 974; 45% male) were surveyed twice over an academic year and reported on their personal substance use and their perception of peer substance use. The sample ranged in age from 10 to 15 years at Time 1 (M age = 11.95) and was 44% White, 26% Latino, 7% Asian American/Pacific Islander, 4% African American, and 14% mixed ethnic origin. RESULTS:Hierarchical regressions examined whether personal and perceived peer substance use predicted later substance involvement, and logistic regressions assessed whether Time 1 perceived peer and personal use of other substances discriminated between initiates and noninitiates. After controlling for personal substance use, perceived peer alcohol use predicted both increased alcohol and marijuana use, and perceived peer marijuana use predicted increased alcohol use. Only perceived peer alcohol use was associated with initiation of alcohol, and both perceived peer alcohol and marijuana use predicted onset of marijuana use. CONCLUSIONS:Results highlight the importance of perceived peer use in predicting both onset and escalation of use and suggest utilizing a multifaceted prevention approach that targets multiple substances.
    背景与目标: 目的:初中是物质使用开始的高峰期。本研究评估了六年级,七年级和八年级学生的同伴影响对吸烟,酗酒和使用大麻的引发和升级的影响。
    方法:青年(n = 974; 45%的男性)在一个学年内接受了两次调查,并报告了他们的个人物质使用情况以及对同龄人物质使用情况的看法。样本在时间1的年龄介于10到15岁(M年龄= 11.95),是44%的白人,26%的拉丁裔,7%的亚裔美国人/太平洋岛民,4%的非洲裔美国人和14%的混合种族。
    结果:等级回归分析了个人和感知的同龄人物质使用是否预测了以后的物质参与,而逻辑回归评估了时间1感知的对等物和个人对其他物质的使用是否区分了发起者和非发起者。在控制了个人物质使用之后,感知到的同龄人的饮酒可以预测酒精和大麻的使用增加,而感知到的同龄人的大麻消费则可以预测增加的酒精使用。只有知觉的同伴饮酒与饮酒的开始有关,知觉的同伴饮酒和大麻的使用都可以预测大麻的发作。
    结论:结果突出了感知到的同龄人的使用在预测使用的发作和升级中的重要性,并建议采用针对多种物质的多方面预防方法。
  • 【护理管理员在管理住院单元使用PDA方面的经验。】 复制标题 收藏 收藏
    DOI:10.1097/00024665-200609000-00010 复制DOI
    作者列表:Lee TT
    BACKGROUND & AIMS: :The adoption of information technology in patient care has become a trend in healthcare organizations. The impact of this technology on end users has been widely studied, but little attention has been given to its influence from a management perspective. The purpose of this study was to explore nurse managers' perceived experiences in implementing a policy to adopt personal digital assistant technology. A descriptive, exploratory qualitative approach (one-on-one, in-depth interviews) was used to collect data from 16 nurse managers of inpatient units at a medical center in Taiwan. Interview data were analyzed according to Miles and Huberman's data reduction, data display, and conclusion verification process. The results revealed that nurse managers experienced the limitations of technology, training issues, doctors' obstructive influence, role conflict, and improvement of future personal digital assistant use. These results can be used to improve strategic organizational planning and in-service training programs to implement information systems.
    背景与目标: :在患者护理中采用信息技术已成为医疗保健组织中的一种趋势。这项技术对最终用户的影响已得到广泛研究,但从管理的角度来看,对其影响的关注很少。这项研究的目的是探讨护士经理在实施采用个人数字助理技术的政策时的经验。采用描述性,探索性定性方法(一对一,深入访谈)收集了台湾医疗中心住院部门16位护士经理的数据。根据Miles和Huberman的数据缩减,数据显示和结论验证过程对访谈数据进行了分析。结果表明,护士经理遇到了技术限制,培训问题,医生的阻碍性影响,角色冲突以及未来个人数字助理使用的改善。这些结果可用于改进战略性组织计划和在职培训计划,以实施信息系统。
  • 【验证了绿色荧光蛋白标记的创伤弧菌菌株,用于评估生牡蛎的捕捞后策略。】 复制标题 收藏 收藏
    DOI:10.1128/AEM.01091-06 复制DOI
    作者列表:Drake SL,Elhanafi D,Bang W,Drake MA,Green DP,Jaykus LA
    BACKGROUND & AIMS: :In this paper we describe a biological indicator which can be used to study the behavior of Vibrio vulnificus, an important molluscan shellfish-associated human pathogen. A V. vulnificus ATCC 27562 derivative that expresses green fluorescent protein (GFP) and kanamycin resistance was constructed using conjugation. Strain validation was performed by comparing the GFP-expressing strain (Vv-GFP) and the wild-type strain (Vv-WT) with respect to growth characteristics, heat tolerance (45 degrees C), freeze-thaw tolerance (-20(o) and -80 degrees C), acid tolerance (pH 5.0, 4.0, and 3.5), cold storage tolerance (5 degrees C), cold adaptation (15 degrees C), and response to starvation. Levels of recovery were evaluated using nonselective medium (tryptic soy agar containing 2% NaCl) with and without sodium pyruvate. The indicator strain was subsequently used to evaluate the survival of V. vulnificus in oysters exposed to organic acids (citric and acetic acids) and various cooling regimens. In most cases, Vv-GFP was comparable to Vv-WT with respect to growth and survival upon exposure to various biological stressors; when differences between the GFP-expressing and parent strains occurred, they usually disappeared when sodium pyruvate was added to media. When V. vulnificus was inoculated into shellstock oysters, the counts dropped 2 log(10) after 11 to 12 days of refrigerated storage, regardless of the way in which the oysters were initially cooled. Steeper population declines after 12 days of refrigerated storage were observed for both iced and refrigerated products than for slowly cooled product and product held under conservative harvest conditions. By the end of the refrigeration storage study (22 days), the counts of Vv-GFP in iced and refrigerated oysters had reached the limit of detection (10(2) CFU/oyster), but slowly cooled oysters and oysters stored under conservative harvest conditions still contained approximately 10(3) and >10(4) CFU V. vulnificus/oyster by day 22, respectively. The Vv-GFP levels in the oyster meat remained stable for up to 24 h when the meat was exposed to acidic conditions at various pH values. Ease of detection and comparability to the wild-type parent make Vv-GFP a good candidate for use in studying the behavior of V. vulnificus upon exposure to sublethal stressors that might be encountered during postharvest handling of molluscan shellfish.
    背景与目标: :在本文中,我们描述了一种生物指示剂,可用于研究创伤弧菌(一种与软体动物贝类有关的重要人类病原体)的行为。使用缀合构建表达绿色荧光蛋白(GFP)和卡那霉素抗性的V. vulnificus ATCC 27562衍生物。通过比较表达GFP的菌株(Vv-GFP)和野生型菌株(Vv-WT)的生长特性,耐热性(45°C),冻融耐受性(-20(o )和-80摄氏度),耐酸性(pH 5.0、4.0和3.5),冷藏(5摄氏度),冷适应(15摄氏度)和对饥饿的反应。使用有和没有丙酮酸钠的非选择性培养基(胰蛋白酶大豆琼脂含2%NaCl)评估回收水平。该指示菌株随后用于评估暴露于有机酸(柠檬酸和乙酸)和各种冷却方案的牡蛎中创伤弧菌的存活。在大多数情况下,就暴露于各种生物胁迫下的生长和存活而言,Vv-GFP可与Vv-WT媲美。当表达GFP的菌株和亲本菌株之间出现差异时,通常在向培养基中添加丙酮酸钠后它们消失。当将V. vulnificus接种到带壳牡蛎中时,无论最初冷却牡蛎的方式如何,在冷藏11至12天后,其计数都下降了2 log(10)。与冷藏产品和在保守收获条件下保存的产品相比,冷藏和冷藏产品在冷藏存储12天后的直立种群减少。到冷藏存储研究结束时(22天),冰牡蛎和冷藏牡蛎中的Vv-GFP数量已达到检测极限(10(2)CFU /牡蛎),但缓慢冷却的牡蛎和保守收获的牡蛎到第22天时,条件仍分别包含大约10(3)和> 10(4)CFU创伤弧菌/牡蛎。当将牡蛎肉暴露于各种pH值的酸性条件下时,牡蛎肉中的Vv-GFP水平保持稳定长达24小时。 Vv-GFP易于检测且与野生型亲本具有可比性,因此非常适合用于研究在捕食软体动物贝类后可能会遇到的亚致死应激源下的V. vulnificus行为。
  • 【计算机辅助诊断方案,用于通过随访放大的乳房X线照片来识别簇状微钙化的组织学分类。】 复制标题 收藏 收藏
    DOI:10.1016/j.acra.2006.07.005 复制DOI
    作者列表:Nakayama R,Watanabe R,Namba K,Takeda K,Yamamoto K,Katsuragawa S,Doi K
    BACKGROUND & AIMS: RATIONALE AND OBJECTIVES:Our purpose in this study was to investigate the usefulness of follow-up magnification mammograms (i.e., both current and previous magnification mammograms) in a computer-aided diagnosis (CAD) scheme for identifying the histological classification of clustered microcalcifications. MATERIALS AND METHODS:Our database consisted of current and previous magnification mammograms obtained from 93 patients before and after 3-month follow-up: 11 invasive carcinomas, 19 noninvasive carcinomas of the comedo type, 25 noninvasive carcinomas of the noncomedo type, 23 mastopathies, and 15 fibroadenomas. In our CAD scheme, we extracted five objective features of clustered microcalcifications from each of the current and previous magnification mammograms by taking into account image features that experienced radiologists commonly use to identify histological classifications. These features were then merged by a modified Bayes discriminant function for distinguishing among five histological classifications. For the input of the modified Bayes discriminant function, we used five objective features obtained from the previous magnification mammogram (previous features), five objective features obtained from the current magnification mammogram (current features), and the set of the five previous features and the five current features. RESULTS:The classification accuracies with the five current features were higher than those with the five previous features. These classification accuracies were improved substantially by using the set of the five previous features and the five current features. For the set of the five previous features and the five current features, the classification accuracies of our CAD scheme were 81.8% (9 of 11) for invasive carcinoma, 84.2% (16 of 19) for noninvasive carcinoma of the comedo type, 76.0% (19 of 25) for noninvasive carcinoma of the noncomedo type, 73.9% (17 of 23) for mastopathy, and 86.8% (13 of 15) for fibroadenoma. CONCLUSION:Our CAD scheme with use of follow-up magnification mammograms improved classification performance for mammographic clustered microcalcifications.
    背景与目标: 理由和目的:我们在这项研究中的目的是研究在计算机辅助诊断(CAD)方案中对后续放大的乳房X线照片(即当前和以前的放大X线照片)的有效性,以识别簇状微钙化的组织学分类。
    材料和方法:我们的数据库包含从3个月的随访前后的93例患者获得的当前和以前的放大乳房X线照片:11个浸润性癌,19个粉刺型非浸润性癌,25个非粉刺型非浸润性癌,23个乳腺病,和15个纤维腺瘤。在我们的CAD方案中,我们通过考虑经验丰富的放射科医生通常用来识别组织学分类的图像特征,从当前和以前的放大倍数乳房X线照片中提取出簇状微钙化的五个客观特征。然后,通过改进的贝叶斯判别函数合并这些特征,以在五种组织学分类之间进行区分。对于修改的贝叶斯判别函数的输入,我们使用了从先前的放大倍数X线照片(先前的特征)获得的五个客观特征,从当前的放大倍数X线图(当前特征)获得的五个客观特征,以及五个先前的特征和当前的五个功能。
    结果:具有五个当前特征的分类准确度高于具有五个先前特征的分类准确度。通过使用五个先前功能和五个当前功能的集合,大大提高了这些分类的准确性。对于这五个先前特征和五个当前特征的集合,我们的CAD方案的分类准确度对于浸润性癌为81.8%(11个中的9个),粉刺型非浸润性癌为84.2%(19个中的16个),76.0%对于非粉刺型非侵袭性癌,其诊断率为(25分之19),对于乳腺病为73.9%(23分之17),对于纤维腺瘤则为86.8%(15分之13)。
    结论:我们的CAD方案采用了后续放大的乳腺X线照片,改善了乳腺X线照相群集微钙化的分类性能。
  • 【2001-2014年,青少年和年轻人中丁丙诺啡和纳曲酮对阿片类药物使用障碍的接受趋势。】 复制标题 收藏 收藏
    DOI:10.1001/jamapediatrics.2017.0745 复制DOI
    作者列表:Hadland SE,Wharam JF,Schuster MA,Zhang F,Samet JH,Larochelle MR
    BACKGROUND & AIMS: Importance:Opioid use disorder (OUD) frequently begins in adolescence and young adulthood. Intervening early with pharmacotherapy is recommended by major professional organizations. No prior national studies have examined the extent to which adolescents and young adults (collectively termed youth) with OUD receive pharmacotherapy. Objective:To identify time trends and disparities in receipt of buprenorphine and naltrexone among youth with OUD in the United States. Design, Setting, and Participants:A retrospective cohort study was conducted using deidentified data from a national commercial insurance database. Enrollment and complete health insurance claims of 9.7 million youth, aged 13 to 25 years were analyzed, identifying individuals who received a diagnosis of OUD between January 1, 2001, and June 30, 2014, with final follow-up date December 31, 2014. Analysis was conducted from April 25 to December 31, 2016. Time trends were identified and multivariable logistic regression was used to determine sociodemographic factors associated with medication receipt. Exposures:Sex, age, race/ethnicity, neighborhood education and poverty levels, geographic region, census region, and year of diagnosis. Main Outcomes and Measures:Dispensing of a medication (buprenorphine or naltrexone) within 6 months of first receiving an OUD diagnosis. Results:Among 20 822 youth diagnosed with OUD (0.2% of the 9.7 million sample), 13 698 (65.8%) were male and 17 119 (82.2%) were non-Hispanic white. Mean (SD) age was 21.0 (2.5) years at the first observed diagnosis. The diagnosis rate of OUD increased nearly 6-fold from 2001 to 2014 (from 0.26 per 100 000 person-years to 1.51 per 100 000 person-years). Overall, 5580 (26.8%) youth were dispensed a medication within 6 months of diagnosis, with 4976 (89.2%) of medication-treated youth receiving buprenorphine and 604 (10.8%) receiving naltrexone. Medication receipt increased more than 10-fold, from 3.0% in 2002 (when buprenorphine was introduced) to 31.8% in 2009, but declined in subsequent years (27.5% in 2014). In multivariable analyses, younger individuals were less likely to receive medications, with adjusted probability for age 13 to 15 years, 1.4% (95% CI, 0.4%-2.3%); 16 to 17 years, 9.7% (95% CI, 8.4%-11.1%); 18 to 20 years, 22.0% (95% CI, 21.0%-23.0%); and 21 to 25 years, 30.5% (95% CI, 30.0%-31.5%) (P < .001 for difference). Females (7124 [20.3%]) were less likely than males (13 698 [24.4%]) to receive medications (P < .001), as were non-Hispanic black (105 [14.8%]) and Hispanic (1165 [20.0%]) youth compared with non-Hispanic white (17 119 [23.1%]) youth (P < .001). Conclusions and Relevance:In this first national study of buprenorphine and naltrexone receipt among youth, dispensing increased over time. Nonetheless, only 1 in 4 commercially insured youth with OUD received pharmacotherapy, and disparities based on sex, age, and race/ethnicity were observed.
    背景与目标: 重要性:阿片类药物使用障碍(OUD)经常在青春期和成年期开始。主要专业组织建议尽早进行药物治疗。以前的国家研究都没有研究OUD的青少年和年轻人(统称为青年)接受药物治疗的程度。
    目的:确定美国OUD青年中丁丙诺啡和纳曲酮的接受时间趋势和差异。
    设计,地点和参与者:使用来自国家商业保险数据库的身份不明数据进行回顾性队列研究。分析了970万年龄在13至25岁之间的970万青年人的入学和完整健康保险理赔,确定了在2001年1月1日至2014年6月30日期间被诊断为OUD的个人,最终随访日期为2014年12月31日。分析于2016年4月25日至12月31日进行。确定了时间趋势,并使用多变量logistic回归确定与用药相关的社会人口统计学因素。
    暴露:性别,年龄,种族/民族,邻里教育和贫困程度,地理区域,人口普查区域和诊断年份。
    主要结果和措施:在首次接受OUD诊断后的6个月内分发药物(丁丙诺啡或纳曲酮)。
    结果:在20822名被诊断为OUD的青年中(占970万样本的0.2%),男性中有13698名(65.8%),非西班牙裔白人中有17119名(82.2%)。在首次观察到的诊断中,平均(SD)年龄为21.0(2.5)岁。从2001年到2014年,OUD的诊断率增长了近6倍(从每100000人年0.26增至每100000人年1.51)。总体而言,在诊断后的6个月内分配了5580(26.8%)名年轻人用药,其中接受丁丙诺啡的4976(89.2%)名接受药物治疗的青年人和接受纳曲酮的604名(10.8%)。药物治疗的收入增加了十倍以上,从2002年的3.0%(引入丁丙诺啡时)到2009年的31.8%,但随后几年却下降了(2014年为27.5%)。在多变量分析中,年龄较小的个体接受药物治疗的可能性较小,年龄调整为13至15岁的概率为1.4%(95%CI,0.4%-2.3%); 16至17年,9.7%(95%CI,8.4%-11.1%); 18至20年,22.0%(95%CI,21.0%-23.0%);和21至25年,分别为30.5%(95%CI,30.0%-31.5%)(差异P <<。001)。与非西班牙裔黑人(105名[14.8%])和西班牙裔(1165名[20.0])相比,女性(7124名[20.3%])与男性(13698名[24.4%])接受药物治疗的可能性较小(P <.001)。 %]青年与非西班牙裔白人(17119 [23.1%])青年相比(P <.001)。
    结论和相关性:在这项关于丁丙诺啡和纳曲酮的年轻人接受的首次国家研究中,随着时间的流逝,配药量增加了。尽管如此,只有四分之一的有OUD的商业保险青年接受了药物治疗,并且观察到了基于性别,年龄和种族/民族的差异。

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