BACKGROUND & AIMS: In almost all countries, the critical point for defining the nutritional status of a population is represented by the poor source of representative data of the whole population or of the main subgroups of the population. Also, in Italy, the sources of data on the nutritional status of biochemically evaluated macro- and micronutrients are scant in relation to specific groups of the population, mainly children and the elderly. In this short review, only the nutritional status for vitamins is considered. The existing limited data, however, indicate that clinical signs of severe deficiency are not observed in Italy and the incidence of vitamin malnutrition is moderate. This is probably due to the large availability and variety of food and to Italian eating habits which reflect the typical Mediterranean dietrich, for example, in cereals, fresh fruit and vegetables, and olive oil. However, there are particular conditions, linked to lifestyle, in which the risk of a mild or moderate vitamin malnutrition increases. These include a monotonous diet, drug interactions, smoking habits and alcohol consumption.

背景与目标： 在几乎所有国家中，界定人口营养状况的关键点是整个人口或人口主要子群体代表性数据的来源不多。同样，在意大利，与生化评估的大量和微量营养素的营养状况有关的数据来源相对于特定人群（主要是儿童和老年人）而言很少。在这篇简短的评论中，仅考虑了维生素的营养状况。然而，现有的有限数据表明，在意大利未观察到严重缺乏的临床迹象，维生素营养不良的发生率中等。这可能是由于食物的可获得性和种类繁多以及意大利人的饮食习惯，这些饮食习惯反映了典型的地中海饮食，例如谷物，新鲜水果和蔬菜以及橄榄油中的饮食。但是，在与生活方式相关的某些特殊条件下，轻度或中度维生素营养不良的风险会增加。这些包括单调饮食，药物相互作用，吸烟习惯和饮酒。

BACKGROUND & AIMS: :We investigated the ability of systolic and diastolic carotid artery longitudinal wall motion (CALM) to delineate expected differences in arterial health in individuals representing a range of both age and health status. We recruited 161 younger healthy adults (aged 24 ± 5 y), 51 older healthy adults (aged 70 ± 5 y) and 14 adults with coronary artery disease (aged 67 ± 8 y) for resting assessment of CALM and arterial stiffness. All CALM parameters were reduced in the old healthy adults and adults with coronary artery disease compared with the young healthy adults (p < 0.01), with diastolic velocity and maximum diastolic acceleration being further reduced in the adults with coronary artery disease than in the older healthy adults (p < 0.01). Diastolic CALM parameters were more strongly related to age (β range: -0.46 to -0.53) than systolic CALM parameters (β range: -0.24 to -0.44). In contrast to previous examinations of a variety of CALM parameters, diastolic CALM may provide superior promise in terms of characterizing arterial wall properties, with additional sensitivity to cardiovascular disease status.

背景与目标： ：我们研究了代表年龄和健康状况范围的个体的收缩和舒张颈动脉纵向壁运动（CALM）描绘动脉健康预期差异的能力。我们招募了161名较年轻的健康成年人（24岁±5岁），51名较健康的成年人（70±5岁）和14名患有冠心病的成年人（67±8岁）进行了CALM和动脉僵硬度的静息评估。与年轻健康成年人相比，老年健康成年人和患有冠状动脉疾病的成年人的所有CALM参数均降低（p <0.01），与老年健康成年人相比，冠状动脉疾病的成年人的舒张速度和最大舒张加速进一步降低成人（p <0.01）。舒张期CALM参数与年龄（β范围：-0.46至-0.53）的相关性比收缩期CALM参数（β范围：-0.24至-0.44）更密切。与以前对各种CALM参数的检查相比，舒张期CALM在表征动脉壁特性方面可能具有更好的前景，并且对心血管疾病的状态更加敏感。

BACKGROUND & AIMS: :The TIM (T cell/transmembrane, immunoglobulin and mucin) proteins are crucial regulators of Th1/Th2 immune responses and have been implicated in several diseases including HIV-1/AIDS. The TIM1 exon 4 that codes for mucin domain is highly diverse, with sequence variants associated with varying phenotypes. In this study, TIM1 exon 4 was sequenced among 227 HIV-1 seroprevalent and 288 healthy non infected individuals from North Indian population and haplotypes established. A novel but rare haplotype D1(∗) was identified among the healthy and differed from D1 by a synonymous substitution G>T at Thr208Thr. The TIM1 haplotype diversity showed no association with susceptibility to HIV-1 infection. The seroprevalent individuals carrying D3A had relatively higher median CD4+T cell counts (368/μl) than those without (313/μl; p=0.02). A comparison of CD4+T counts between D3-A individuals on ART or ART naïve did not show any significant difference plausibly due to confounding nature of ART and other factors.

背景与目标： TIM（T细胞/跨膜，免疫球蛋白和粘蛋白）蛋白是Th1 / Th2免疫反应的关键调节剂，并与包括HIV-1 / AIDS在内的多种疾病有关。编码粘蛋白结构域的TIM1外显子4高度多样化，具有与不同表型相关的序列变体。在这项研究中，TIM1外显子4在来自北印度人口的227个HIV-1血清流行和288个健康的未感染个体中进行了测序，并建立了单倍型。在健康人群中鉴定出一种新颖但罕见的单倍型D1（∗），与D1的区别在于在Thr208Thr处的同义替代G> T。 TIM1单倍型多样性表明与HIV-1感染的易感性无关。携带D3A的血清流行个体的CD4 T细胞计数中位数相对较高（不含313 /μl； p = 0.02）。由于ART和其他因素的混杂，D3-A个体或未接受过ART的D3-A个体之间CD4 T计数的比较似乎没有显示任何显着差异。

BACKGROUND & AIMS: :The effect of ascorbic acid on iron retention from a diet with predicted low iron bioavailability (containing minimal meat and ascorbic acid) was investigated in iron-depleted premenopausal women. Eleven women were depleted of storage iron (indicated by serum ferritin) through a combination of diet (5.0 mg Fe/2000 kcal for 67-88 d) and phlebotomy. They then consumed a diet containing 13.7 mg Fe/2000 kcal, supplemented with placebo or ascorbic acid three times daily (1500 mg total) with meals for 5.5 wk. Ascorbic acid improved apparent iron absorption (balance method) [38 +/- 2% (means +/- SEM) vs 27 +/- 2%]. Ascorbic acid also improved hemoglobin, erythrocyte protoporphyrins, and serum iron but not hematocrit, serum ferritin, iron-binding capacity, or transferrin saturation. In iron-depleted women consuming a diet with predicted poor iron availability, ascorbic acid supplementation enhanced body iron retention for 5.5 wk.

背景与目标： ：在缺铁的绝经前妇女中研究了抗坏血酸对铁的生物滞留量具有预期低铁含量（含少量肉和抗坏血酸）的饮食中铁保留的影响。通过饮食（5.0 mg Fe / 2000 kcal，67-88 d）和静脉放血相结合，耗尽了11名妇女的铁储备（以血清铁蛋白表示）。然后，他们进食了含有13.7 mg Fe / 2000 kcal的饮食，每天补充3次（共1500 mg）安慰剂或抗坏血酸，每顿5.5周。抗坏血酸改善了表观铁的吸收（平衡法）[38 /-2％（平均值/-SEM）对27 /-2％]。抗坏血酸还可以改善血红蛋白，红血球原卟啉和血清铁，但不能改善血细胞比容，血清铁蛋白，铁结合能力或转铁蛋白饱和度。在饮食中铁含量低的女性中，铁的可利用性预计较差，补充抗坏血酸可增加体内铁保持5.5周。

BACKGROUND & AIMS: BACKGROUND:Optimal burn care is provided at specialized burn centers. Given the geographic location of these centers, many burn patients receive initial treatment at local emergency departments prior to transfer. The purpose of this study was to determine whether patients transferred from other facilities have worse outcomes than those admitted directly from the field. STUDY DESIGN:A retrospective cohort study was performed comparing the outcomes of patients admitted to our burn center directly from the field with patients requiring transfer from a preliminary care facility. The outcomes of interest were mortality, length of stay, length of stay/TBSA burned, number of operations and hospital charges. Poisson regression or Cox proportional hazards model was used to evaluate differences in outcomes after adjusting for potential confounders. RESULTS:From 2000 to 2003 a total of 1877 patients were admitted to our burn center and 953 (51%) were transferred from a preliminary care facility. No difference (p<0.05) was found in length of stay, number of operations, hospital charges and mortality between the two cohorts. CONCLUSIONS:This study demonstrates that patients transferred to a regional burn center from local hospitals have equivalent mortality, length of stay and hospital charges as those admitted directly from the field.

背景与目标： 背景：在专门的烧伤中心提供最佳烧伤护理。考虑到这些中心的地理位置，许多烧伤患者在转移之前会先在当地急诊科接受初步治疗。这项研究的目的是确定从其他机构转移来的患者是否比直接从现场接受的患者具有更差的结局。
研究设计：进行了一项回顾性队列研究，比较了直接从现场进入我们烧伤中心的患者与需要从初级保健机构转诊的患者的结局。感兴趣的结果是死亡率，住院时间，住院时间/ TBSA烧伤，手术次数和医院费用。泊松回归或Cox比例风险模型用于评估潜在混杂因素后评估结局的差异。
结果：从2000年到2003年，共有1877名患者被收录到我们的烧伤中心，其中953名（51％）从初级护理机构转入了治疗。两组的住院时间，手术次数，住院费用和死亡率均无差异（p <0.05）。
结论：这项研究表明，从当地医院转移到区域烧伤中心的患者的死亡率，住院时间和住院费用与直接从现场住院的患者相同。

BACKGROUND & AIMS: :Male breast cancer (MBC) is an uncommon neoplasm that shares several biologic characteristics with its female counterpart. In the latter, abnormalities in the expression and/or copy number of the ERBB2 gene are present in 10% to 30% of invasive carcinoma and behave as poor prognostic markers. ERBB2 abnormalities have also been reported in MBC, yet at lower frequency, but their prognostic significance remains controversial. Furthermore, no study has addressed the impact of chromosome 17 abnormalities in MBC survival. In this study, the ERBB2-gene status (overexpression and amplification) and chromosome 17 numerical abnormalities were investigated in a series of 50 archival cases of MBC. The results, together with patient's age, histologic grade, pathologic stage, and estrogen receptor status were correlated with overall survival. ERBB2-protein overexpression was present in 7 cases (14%), ERBB2-gene amplification in 4 (8%), and aneuploidy of chromosome 17 in 12 cases (33.3%). The pathologic stage, ERBB2 overexpression and ERBB2 amplification were significantly correlated with overall survival (P=0.002, 0.016, and 0.009, respectively). No correlation was observed between chromosome 17 aneuploidy and overall survival. Therefore, despite their low incidence in MBC, expression abnormalities of ERBB2 behave, together with the pathologic stage of the tumor, as predictors of overall survival, akin to what has been reported for its female counterpart.

背景与目标： ：男性乳腺癌（MBC）是一种罕见的肿瘤，与女性乳腺癌具有某些生物学特性。在后者中，ERBB2基因表达和/或拷贝数异常存在于10％至30％的浸润性癌中，并表现为不良的预后指标。在MBC中也有ERBB2异常的报道，但频率较低，但其预后意义仍存在争议。此外，还没有研究解决17号染色​​体异常对MBC生存的影响。在这项研究中，对一系列50例MBC存档病例中的ERBB2基因状态（过表达和扩增）和17号染色​​体数字异常进行了研究。结果，以及患者的年龄，组织学等级，病理分期和雌激素受体状态与总体生存率相关。 ERBB2蛋白过表达7例（14％），ERBB2基因扩增4例（8％），染色体17的非整倍性12例（33.3％）。病理分期，ERBB2过表达和ERBB2扩增与总生存率显着相关（分别为P = 0.002、0.016和0.009）。在第17号染色​​体非整倍性与总体存活率之间未发现相关性。因此，尽管其在MBC中的发病率较低，但ERBB2的表达异常以及肿瘤的病理阶段仍可作为总体存活率的预测指标，类似于其女性对应物的报道。

BACKGROUND & AIMS: :Polychromatic flow-cytometric assays were used to analyze paired intrahepatic and peripheral lymphocyte samples from 37 patients with chronic hepatitis C. Compared with peripheral cells, intrahepatic T cells were selectively enriched with CD45RO+ memory T cells but had a lower percentage of CD4+ T cells expressing the differentiation markers CD27 and CD28. The percentage of intrahepatic CD45RO+ and CD28+ T cells correlated with the degree of liver inflammation, which suggests that memory T cells at relatively early stages of differentiation are directly involved in liver inflammation. Despite their memory phenotype, intrahepatic T cells were defective in proliferation capability, produced less interferon- gamma in response to stimulation by T cell receptor, and contained less perforin but expressed higher levels of Fas and Fas ligand, compared with their counterparts in peripheral blood. The distinct characteristics of intrahepatic T cells suggest that they play an important role in the immunopathogenesis of chronic hepatitis C.

背景与目标： ：采用多色流式细胞术分析了37例慢性丙型肝炎患者的肝内和外周血淋巴细胞配对样本。与外周血细胞相比，肝内T细胞选择性富集了CD45RO记忆T细胞，但表达CD4 T细胞的百分比较低分化标记CD27和CD28。肝内CD45RO和CD28 T细胞的百分比与肝脏炎症程度相关，这表明处于分化早期的记忆T细胞直接参与肝脏炎症。尽管具有记忆表型，但与外周血中的肝细胞相比，肝内T细胞在T细胞受体的刺激下应答能力较弱，产生的干扰素γ较少，穿孔素含量较低，但表达的Fas和Fas配体水平较高。肝内T细胞的独特特征表明它们在慢性丙型肝炎的免疫发病机制中起着重要作用。

BACKGROUND & AIMS: :The hepatitis C virus (HCV) infects 3% of the world's population, or approximately 170 million people. Most of those acutely infected progress to chronic infection and are unresponsive to existing antiviral treatment. Over a 20-year period, chronic HCV infection leads to cirrhosis and the sequelae of end-stage liver disease, including hepatic encephalopathy, ascites, variceal haemorrhage and hepatocellular carcinoma. Orthotopic liver transplantation (OLT) is the optimal treatment for decompensated HCV cirrhosis, but is limited by organ availability and universal graft reinfection. This review discusses the results with OLT for HCV from the Dumont-UCLA Liver Transplant Center and discusses future directions in the management of HCV.

背景与目标： ：丙型肝炎病毒（HCV）感染了全球3％的人口，约有1.7亿人。大多数急性感染者会发展为慢性感染，并且对现有的抗病毒治疗无反应。在20年的时间里，慢性HCV感染会导致肝硬化和终末期肝病的后遗症，包括肝性脑病，腹水，静脉曲张出血和肝细胞癌。原位肝移植（OLT）是失代偿性HCV肝硬化的最佳治疗方法，但受到器官可用性和通用移植物再感染的限制。这篇综述讨论了Dumont-UCLA肝移植中心使用OLT进行HCV的结果，并讨论了HCV管理的未来方向。

BACKGROUND & AIMS: BACKGROUND:The relationship between bone health and adiposity and how it may be affected in people with chronic metabolic conditions is complex. METHODS:Seventeen women with type 1 diabetes mellitus (T1DM) and nine age-matched healthy women with a median age of 22.6 years (range, 17.4, 23.8) were studied by 3T MRI and MR spectroscopy to assess abdominal adiposity, tibial bone microarchitecture and vertebral bone marrow adiposity (BMA). Additional measures included DXA-based assessments of total body (TB), femoral neck (FN) and lumbar spine (LS) bone mineral density (BMD) and fat mass (FM). RESULTS:Although women with T1DM had similar BMI and BMA to the controls, they had higher visceral and subcutaneous adiposity on MRI (P<.05) and total body FM by DXA (P=.03). Overall, in the whole cohort, a clear inverse association was evident between BMA and BMD at all sites (P<.05). These associations remained significant after adjusting for age, BMI, FM and abdominal adiposity. In addition, visceral adiposity, but not subcutaneous adiposity, showed a positive association with BMA (r, .4, P=.03), and a negative association with total body BMD (r, .5, P=.02). Apparent trabecular separation as assessed by MRI showed an inverse association to total body BMD by DXA (r, -.4, P=.04). CONCLUSION:Irrespective of the presence of an underlying metabolic condition, young women display a negative relationship between MRI-measured BMA and DXA-based assessment of BMD. Furthermore, an association between BMA and visceral adiposity supports the notion of a common origin of these two fat depots.

背景与目标： 背景：在慢性代谢疾病患者中，骨骼健康与肥胖之间的关系及其可能受到的影响是复杂的。
方法：通过3T MRI和MR光谱法研究了17位1型糖尿病（T1DM）妇女和9位年龄相匹配的健康女性（中位年龄为22.6岁，范围分别为17.4、23.8），以评估腹部肥胖，胫骨微结构和椎骨肥胖症（BMA）。其他措施包括基于DXA的全身（TB），股骨颈（FN）和腰椎（LS）骨矿物质密度（BMD）和脂肪量（FM）评估。
结果：尽管患有T1DM的女性的BMI和BMA与对照组相似，但其MRI的内脏和皮下脂肪率较高（P <.05），而DXA显示的全身FM较高（P = .03）。总体而言，在整个队列中，BMA和BMD在所有位点之间均存在明显的逆相关性（P <.05）。在调整了年龄，BMI，FM和腹部肥胖后，这些关联仍然很显着。此外，内脏脂肪而不是皮下脂肪与BMA呈正相关（r，.4，P = .03），与全身BMD呈负相关（r，.5，P = .02）。 MRI评估的表观小梁分离显示，DXA与全身BMD呈负相关（r，-。4，P = .04）。
结论：无论是否存在潜在的代谢状况，年轻女性在MRI测量的BMA与基于DXA的BMD评估之间均显示负相关。此外，BMA和内脏肥胖之间的联系支持了这两个脂肪库的共同起源这一概念。

BACKGROUND & AIMS: BACKGROUND:A growing body of literature shows that many universities and colleges are making educational portfolios part of their faculty assessment and student's learning plan for both undergraduate and graduate programs. We provide an outline for the development of a medical educator's portfolio, including an electronic version. DESCRIPTION:Guidelines for the development of an educational portfolio focusing on medical education are provided, including design, format, and content. An electronic version of the portfolio, which combines flexibility and ease of revision, is also described, including formats for publication and distribution. Student reflections on the e-portfolio are presented, and potential applications of the e-portfolio in medical education are described. CONCLUSION:We believe that portfolio development is a valuable application that provides rich documentation of participants' educational history, accomplishments, and intellectual property as related to their professional learning and growth.

背景与目标： 背景：越来越多的文献表明，许多大学和学院正在将教育档案袋作为其本科和研究生课程教师评估和学生学习计划的一部分。我们为医学教育者的档案袋的发展提供了一个大纲，包括电子版本。
描述：提供了针对医学教育的教育档案袋的开发指南，包括设计，格式和内容。还介绍了组合的灵活性和易于修改的电子版本，包括发布和分发的格式。介绍了学生对电子档案夹的思考，并描述了电子档案夹在医学教育中的潜在应用。
结论：我们认为，档案袋开发是一个有价值的应用程序，它为参与者的教育历史，成就和与他们的专业学习和成长有关的知识产权提供了丰富的文档。

BACKGROUND & AIMS: :Infused CD34 cell count has a significant impact on transplant outcome. In this retrospective study, we aimed to analyze the impact of donor iron parameters on peripheral blood stem cell (PBSC) collection. A total of 303 related donors were included in the study. The mobilization regimen, recombinant G-CSF, was given for four consecutive days. A CD34+ cell count below 2×106/kg was defined as mobilization failure which was demonstrated in 23 donors (7.6%). Mobilization failure was more frequent in female donors than male donors (13.7% vs 3.4%). Body mass index, mean corpuscular volume, hemoglobin and ferritin levels were found to be lower in donors with mobilization failure. Body mass index was significantly correlated with PBSC count on the 4th day of G-CSF. Body mass index, male gender, mean corpuscular volume and ferritin levels had significant impact on PBSC count. Although PBSC count was found to be similar between female and male donors, female gender was shown to have an adverse impact on PBSC collection, which may be attributed to lower body weight and concurrent iron deficiency.

背景与目标： ：注入的CD34细胞数量对移植结果有重要影响。在这项回顾性研究中，我们旨在分析供体铁参数对外周血干细胞（PBSC）收集的影响。总共303名相关捐助者被纳入研究。连续四天给予了动员方案，即重组G-CSF。低于2×106 / kg的CD34细胞计数被定义为动员失败，这在23个捐献者（7.6％）中得到证实。女性捐赠者的动员失败率比男性捐赠者更高（13.7％vs 3.4％）。发现动员失败的献血者的体重指数，平均红细胞体积，血红蛋白和铁蛋白水平较低。体重指数与G-CSF第4天的PBSC计数显着相关。体重指数，男性，平均红细胞体积和铁蛋白水平对PBSC计数有显着影响。尽管发现雌性和雄性供体之间的PBSC计数相似，但显示出性别对PBSC收集有不利影响，这可能归因于体重减轻和同时发生的铁缺乏症。

BACKGROUND & AIMS: INTRODUCTION:Two global, double-blind, placebo- and active-controlled, phase-3 studies (2-year prevention (n = 1583) and 3-year treatment (n = 7492)) have shown that bazedoxifene (BZA) is safe and effective for prevention and treatment of postmenopausal osteoporosis. OBJECTIVE:To evaluate the efficacy/safety of BZA according to baseline kidney function. METHODS:Data for the BZA 20- and 40-mg and placebo groups from both studies were integrated for assessment of bone turnover markers (BTMs), bone mineral density (BMD), and fracture incidence (treatment study only). Safety was assessed using integrated data for the BZA, placebo, and raloxifene 60-mg groups from both studies. Baseline glomerular filtration rate (GFR) was estimated by the Modification of Diet in Renal Disease Study equation; among subjects with baseline GFR, renal function categories were defined by GFR (ml/min per 1.73 m(2)): normal (GFR ≥ 90; n = 1982), mild impairment (60 ≤ GFR < 90; n = 6032), or moderate/severe impairment (GFR < 60; n = 723). RESULTS:Demographics were similar across treatment groups and within GFR subgroups. Across GFR subgroups, BZA 20 and 40 mg reduced BTM levels and improved lumbar spine and total hip BMD versus placebo. At month 24, there were significant treatment-by-GFR (p = 0.003) and treatment-by-serum creatinine (p = 0.034) interactions for the increase in lumbar spine BMD versus placebo. Fracture incidence was lower with BZA than placebo across all GFR categories, with no treatment-by-GFR interaction. There were no significant differences among treatment groups in incidences of overall, serious, or renal-related adverse events across GFR subgroups. CONCLUSIONS:Mild to moderate kidney impairment did not affect the efficacy and safety of BZA in postmenopausal women.

背景与目标： 简介：两项全球，双盲，安慰剂和活性药物对照的3期研究（2年预防（n = 1583）和3年治疗（n = 7492））表明，巴多昔芬（BZA）是安全的对防治绝经后骨质疏松症有效。
目的：根据基线肾脏功能评估BZA的疗效/安全性。
方法：将两项研究中BZA 20 mg和40 mg以及安慰剂组的数据进行整合，以评估骨转换标志（BTM），骨矿物质密度（BMD）和骨折发生率（仅治疗研究）。使用来自两项研究的BZA，安慰剂和雷洛昔芬60 mg组的综合数据评估安全性。基线肾小球滤过率（GFR）通过“饮食中肾脏疾病研究方程的修正”来估算。在具有基线GFR的受试者中，肾功能类别由GFR（每分钟1.73 m（2 / ml / min））定义：正常（GFR≥90； n = 1982），轻度损伤（60≤GFR <90； n = 6032），或中度/重度损伤（GFR <60； n = 723）。
结果：治疗组之间和GFR亚组内的人口统计学相似。在所有GFR亚组中，与安慰剂相比，BZA 20和40 mg降低了BTM水平，改善了腰椎和全髋BMD。在第24个月时，与安慰剂相比，腰椎BMD的升高，分别有明显的GFR治疗（p = 0.003）和血清肌酐治疗（p = 0.034）相互作用。在所有GFR类别中，BZA的骨折发生率均低于安慰剂，并且没有按GFR进行治疗的相互作用。在治疗组之间，GFR亚组的总体，严重或与肾脏相关的不良事件的发生率无显着差异。
结论：轻度至中度肾功能损害并未影响绝经后妇女BZA的疗效和安全性。

BACKGROUND & AIMS: :With the increasing participation of women in the physician workforce, it is important to understand the sources of differences between male and female physicians' market labour supply for developing effective human resource policies in the health care sector. Gendered associations between family status and physician labour supply are explored in the Canadian labour market, where physicians are paid according to a common fee schedule and have substantial discretion in setting their hours of work. Canadian 1991, 1996, 2001 and 2006 twenty percent census files with 22,407 physician observations are used for the analysis. Although both male and female physicians have statistically indistinguishable hours of market work when never married and without children, married male physicians have higher market hours, and their hours are unchanged or increased with parenthood. In contrast, female physicians have lower market hours when married, and much lower hours when a parent. Little change over time in these patterns is observed for males, but for females two offsetting trends are observed: the magnitude of the marriage-hours effect declined, whereas that for motherhood increased. Preferences and/or social norms induce substantially different labour market outcomes. In terms of work at home, the presence of children is associated with higher hours for male physicians, but for females the hours increase is at least twice as large. A male physician's spouse is much less likely to be employed, and if employed, has lower market hours in the presence of children. In contrast, a female physician's spouse is more likely to be employed if there are three or more children. Both male and female physicians have lower hours of work when married to another physician. Overall, there is no gender difference in physician market labour supply after controlling for family status and demographics.

背景与目标： 随着女性越来越多地参与医师队伍，了解男性和女性医师市场劳动力供应差异的根源对于在医疗保健部门制定有效的人力资源政策非常重要。在加拿大的劳动力市场中，探索了家庭状况和医师劳动力供应之间的性别关联，在该市场中，医师根据共同的费用表获得报酬，并在确定工作时间方面拥有充分的酌处权。加拿大1991年，1996年，2001年和2006年的20％人口普查文件中有22407位医生的观察结果用于分析。尽管从没有结婚和没有孩子的情况下，男性和女性医生的市场工作时间在统计上是无法区分的，但已婚男性医生的市场工作时间更长，并且他们的工作时间随着父母的养育而保持不变或增加。相比之下，女性医师结婚时的市场营业时间较短，而父母一方的市场营业时间较低。在男性中，这些模式随时间的变化很小，但是在女性中，观察到了两个相互抵消的趋势：结婚时间影响的幅度减小了，而孕育时间的影响增大了。偏好和/或社会规范导致劳动力市场的结果大不相同。在家庭工作方面，男医生的工作时间较长，而女性的工作时间至少增加了两倍。男性医师的配偶受雇的可能性要小得多，如果受雇，则在有孩子的情况下其营业时间较短。相反，如果有三个或三个以上的孩子，则更有可能雇用女医生的配偶。与另一位医生结婚时，男性和女性医生的工作时间都较短。总体而言，控制家庭状况和人口统计后，医师市场劳动力供应没有性别差异。

BACKGROUND & AIMS: PURPOSE:In order to engage medical students and residents from public health centers to utilize the telemedicine features of surgery on their own smartphones and tablets as an educational tool, an innovative streaming system was developed with the purpose of streaming live footage from open surgeries to smartphones and tablets, allowing the visualization of the surgical field from the surgeon's perspective. The current study aims to describe the results of an evaluation on level 1 of Kirkpatrick's Model for Evaluation of the streaming system usage during gynecological surgeries, based on the perception of medical students and gynecology residents. METHODS:Consisted of a live video streaming (from the surgeon's point of view) of gynecological surgeries for smartphones and tablets, one for each volunteer. The volunteers were able to connect to the local wireless network, created by the streaming system, through an access password and watch the video transmission on a web browser on their smartphones. Then, they answered a Likert-type questionnaire containing 14 items about the educational applicability of the streaming system, as well as comparing it to watching an in loco procedure. This study is formally approved by the local ethics commission (Certificate No. 53175915.7.0000.5171/2016). RESULTS:Twenty-one volunteers participated, totalizing 294 items answered, in which 94.2% were in agreement with the items affirmative, 4.1% were neutral, and only 1.7% answers corresponded to negative impressions. Cronbach's α was .82, which represents a good reliability level. Spearman's coefficients were highly significant in 4 comparisons and moderately significant in the other 20 comparisons. CONCLUSIONS:This study presents a local streaming video system of live surgeries to smartphones and tablets and shows its educational utility, low cost, and simple usage, which offers convenience and satisfactory image resolution, thus being potentially applicable in surgical teaching.

背景与目标： 目的：为了吸引来自公共卫生中心的医学生和居民在他们自己的智能手机和平板电脑上利用外科手术的远程医疗功能作为教育工具，开发了一种创新的流媒体系统，其目的是将现场录像从开放式手术流向智能手机。和平板电脑，可以从外科医生的角度看到手术区域。本研究旨在根据医学生和妇科住院医师的看法，描述对柯克帕特里克妇科手术流系统使用率评估模型第1级的评估结果。
方法：由智能手机和平板电脑的妇科手术的实时视频流（从外科医生的角度来看）组成，每位志愿者一个。志愿者们能够通过访问密码连接到流系统创建的本地无线网络，并在智能手机的网络浏览器上观看视频传输。然后，他们回答了一个Likert型问卷，其中包含14个有关流系统的教育适用性的项目，并将其与观看本地程序进行了比较。这项研究已获得当地伦理委员会的正式批准（证书编号53175915.7.0000.5171 / 2016）。
结果：21名志愿者参加，总共回答294项，其中94.2％与肯定的回答相符，中立的占4.1％，只有1.7％的回答与负面印象相对应。 Cronbach的α为0.82，表示良好的可靠性水平。 Spearman系数在4个比较中高度显着，在其他20个比较中适度。
结论：本研究为智能手机和平板电脑提供了实时手术的本地流式视频系统，并显示了其教育实用性，低成本和简单易用的特点，提供了便利和令人满意的图像分辨率，因此有可能应用于外科教学。

BACKGROUND & AIMS: :Vitamin D deficiency is associated with osteoporosis and is thought to increase the risk of cancer and CVD. Despite these numerous potential health effects, data on vitamin D status at the population level and within key subgroups are limited. The aims of the present study were to examine patterns of 25-hydroxyvitamin D (25(OH)D) levels worldwide and to assess differences by age, sex and region. In a systematic literature review using the Medline and EMBASE databases, we identified 195 studies conducted in forty-four countries involving more than 168 000 participants. Mean population-level 25(OH)D values varied considerably across the studies (range 4·9-136·2 nmol/l), with 37·3 % of the studies reporting mean values below 50 nmol/l. The highest 25(OH)D values were observed in North America. Although age-related differences were observed in the Asia/Pacific and Middle East/Africa regions, they were not observed elsewhere and sex-related differences were not observed in any region. Substantial heterogeneity between the studies precluded drawing conclusions on overall vitamin D status at the population level. Exploratory analyses, however, suggested that newborns and institutionalised elderly from several regions worldwide appeared to be at a generally higher risk of exhibiting lower 25(OH)D values. Substantial details on worldwide patterns of vitamin D status at the population level and within key subgroups are needed to inform public health policy development to reduce risk for potential health consequences of an inadequate vitamin D status.

背景与目标： 维生素D缺乏症与骨质疏松症相关，被认为会增加罹患癌症和CVD的风险。尽管有许多潜在的健康影响，但在人群水平和关键亚组内维生素D状况的数据仍然有限。本研究的目的是检查世界范围内25-羟基维生素D（25（OH）D）水平的模式，并评估年龄，性别和地区的差异。在使用Medline和EMBASE数据库进行的系统文献综述中，我们确定了在44个国家进行的195项研究，涉及168 000多名参与者。在整个研究中，平均人群水平25（OH）D值相差很大（范围4·9-136·2 nmol / l），其中37·3％的研究报告平均值低于50 nmol / l。在北美观察到最高的25（OH）D值。尽管在亚太地区和中东/非洲地区发现了与年龄有关的差异，但在其他地区未发现与年龄有关的差异，在任何地区都未发现与性别有关的差异。研究之间的实质性异质性无法在人群水平上得出总体维生素D状况的结论。然而，探索性分析表明，来自全球多个地区的新生儿和机构化老年人似乎普遍具有较低的25（OH）D值风险。需要在人群水平和关键亚组内提供有关世界范围内维生素D状况的大量细节，以告知公共卫生政策制定工作，以减少维生素D状况不足对潜在健康后果的风险。