BACKGROUND & AIMS: :Venous thromboembolism (VTE) is a potentially serious complication occurring in 1%-2% of hospitalized medical patients. Despite this low absolute risk, as many as 82% of medical patients are considered to be at increased risk of developing VTE and are eligible for medical thromboprophylaxis. In this commentary, The author will discuss the main findings of a recent paper published in Clinical Epidemiology that questions the large proportion of individuals who are eligible for medical thromboprophylaxis, and also discuss the potential implications for the prevention of VTE. The recent paper demonstrated that when a population is divided into high- and low-risk groups, the maximum absolute risk depends on the inverse of the proportion of patients that is considered to be high risk. Consequently, even an effective treatment will only result in a small reduction in the absolute risk when the high-risk group comprises the largest proportion of this population. For medical thromboprophylaxis, this implies that even patients considered to be at high-risk for developing VTE have a maximum absolute VTE risk of 2% when the overall risk is 1.6%. Therefore, even an effective preventive initiative will only result in a small risk reduction. This small potential benefit should be weighed against potential harms associated with prophylaxis, mainly bleeding events. Still, there may be a reasonable overall balance between prevention of pulmonary embolism and major bleeding, mainly because major bleeding events are rare. Nonetheless, this discussion underscores that future risk prediction models should aim to predict the benefits and harms in individual patients in order to provide optimal care for the right patients.

背景与目标： ：静脉血栓栓塞症（VTE）是潜在的严重并发症，发生在1％-2％的住院医疗患者中。尽管绝对风险较低，但仍有多达82％的医疗患者罹患VTE的风险增加，并且有资格进行医疗血栓预防。在这篇评论中，作者将讨论《临床流行病学》上发表的一篇最新论文的主要发现，该论文质疑有资格进行医学血栓预防的大部分个人，并讨论了预防VTE的潜在意义。最近的论文表明，当将人群分为高风险和低风险组时，最大绝对风险取决于被认为是高风险的患者比例的倒数。因此，当高危人群占该人群的最大比例时，即使是有效的治疗也只会导致绝对风险的少量降低。对于医学上的血栓预防，这意味着即使总风险为1.6％，即使被认为是发生VTE的高风险患者，其绝对VTE的最大绝对风险也为2％。因此，即使是有效的预防措施也只能减少很小的风险。应当权衡这种小的潜在益处，以预防相关的潜在危害，主要是出血事件。仍然，在预防肺栓塞和大出血之间可能存在合理的总体平衡，这主要是因为很少发生大出血事件。尽管如此，本讨论强调指出，未来的风险预测模型应旨在预测个别患者的利弊，以便为​​合适的患者提供最佳护理。

BACKGROUND & AIMS: :Diagnostic accuracy for radiologists is above that expected by chance when they are exposed to a chest radiograph for only one-fifth of a second, a period too brief for more than a single voluntary eye movement. How do radiologists glean information from a first glance at an image? It is thought that this expert impression of the gestalt of an image is related to the everyday, immediate visual understanding of the gist of a scene. Several high-speed mechanisms guide our search of complex images. Guidance by basic features (such as color) requires no learning, whereas guidance by complex scene properties is learned. It is probable that both hardwired guidance by basic features and learned guidance by scene structure become part of radiologists' expertise. Search in scenes may be best explained by a two-pathway model: Object recognition is performed via a selective pathway in which candidate targets must be individually selected for recognition. A second, nonselective pathway extracts information from global or statistical information without selecting specific objects. An appreciation of the role of nonselective processing may be particularly useful for understanding what separates novice from expert radiologists and could help establish new methods of physician training based on medical image perception.

背景与目标： ：放射科医生的诊断准确性高于他们在接受胸部X射线照片仅五分之一秒的机会时所期望的准确性，这个时期太短，无法进行多次自愿的眼球运动。放射科医生如何从乍一看就可以收集信息？可以认为，对图像的格式像的这种专家印象与场景要点的日常，直观的视觉理解有关。几种高速机制可指导我们搜索复杂的图像。基本功能（例如颜色）的指导不需要学习，而复杂场景属性的指导则是学习的。基本功能的硬线指导和场景结构的习得性指导都可能成为放射科医生专业知识的一部分。场景搜索最好用两种途径来解释：对象识别是通过选择性途径进行的，在该途径中必须单独选择候选目标进行识别。第二种非选择性途径可从全局或统计信息中提取信息，而无需选择特定对象。理解非选择性处理的作用对于了解什么将新手与放射线专家区分开来尤其有用，并且可以帮助建立基于医学图像感知的医师培训新方法。

BACKGROUND & AIMS: OBJECTIVES:To evaluate and assess the impact of pharmacy students' electronic device (e-device) use during a lecture-based pharmacotherapeutics sequence. METHODS:A validated survey instrument to assess e-device use was e-mailed to 238 second- (P2) and third-year (P3) pharmacy students. Grades were reviewed retrospectively and correlated with e-device use to determine its impact on academic performance. RESULTS:Of 140 responding students (59% response rate), 106 reported using e-devices during class for course-related (91.5%) and non-course-related (81.1%) activities. When P2 and P3 students were combined, e-device use was not associated with academic performance (p = 0.70). Academic performance was not impacted among P3 students (p = 0.86), but P2 students performed better academically if they refrained from using e-devices during class (mean grade = 88.5% vs. 83.3%; p=0.019). CONCLUSIONS:The impact of e-device use on overall academic performance was negligible. Use of e-devices by students enrolled in their first pharmacotherapeutics course may negatively impact academics.

背景与目标： 目的：评估和评估在以讲座为基础的药物治疗过程中，药房学生使用电子设备（电子设备）的影响。
方法：通过电子邮件将有效的调查工具评估电子设备的使用情况，并通过电子邮件发送给238名二（P2）和三年级（P3）药房学生。对成绩进行回顾性审查，并将其与电子设备的使用相关联，以确定其对学习成绩的影响。
结果：在140名回应学生中（59％的回应率），有106名学生报告说在课堂上使用电子设备进行与课程相关的活动（91.5％）和与课程无关的活动（81.1％）。当P2和P3学生合并时，电子设备的使用与学习成绩无关（p = 0.70）。 P3学生的学业成绩并未受到影响（p = 0.86），但如果P2学生在上课时避免使用电子设备，则他们的学业成绩会更好（平均成绩分别为88.5％和83.3％； p = 0.019）。
结论：电子设备使用对整体学业成绩的影响可以忽略不计。首次参加药物治疗课程的学生使用电子设备可能会对学术产生负面影响。

BACKGROUND & AIMS: :Epilepsy affects a larger number of individuals than previously thought-up to 2% of the population-and its effects reach further. Yet epilepsy, with its associated lingering stigma and fear, has remained in the background in terms of services and research. Traditional quantitative research often falls short when trying to describe the impact of epilepsy on the lives of individuals and their families. In the present study, focus groups were held throughout South Carolina to discuss individuals' experiences with accessing epilepsy-related services and health care, and what life with epilepsy is like. Following qualitative data analysis, findings included two themes. One theme focuses on the ongoing search for services and help. The second theme concerns the experiences of living life with epilepsy. Also highlighted are recommendations for potential improvements in public awareness and professional training, and helpful interventions.

背景与目标： ：癫痫病影响的人数比以前认为的要多，达到2％的人口，其影响进一步扩大。然而，癫痫病及其相关的污名和恐惧缠绵不绝，在服务和研究方面仍处于背景之中。当试图描述癫痫病对个人及其家庭生活的影响时，传统的定量研究往往不足。在本研究中，在整个南卡罗来纳州举行了焦点小组会议，讨论了个人在获得癫痫相关服务和医疗保健方面的经验以及癫痫患者的生活。在对数据进行定性分析之后，发现包括两个主题。一个主题侧重于对服务和帮助的持续搜索。第二个主题涉及癫痫患者的生活经历。还着重介绍了有关可能提高公众意识和专业培训的建议以及有益的干预措施。

BACKGROUND & AIMS: :Egyptian medical papyri date the Santorini eruption, and reconcile the hitherto perceived dichotomy between archaeological/historical and scientific data. The medical documentation describes ailments, which can only have arisen from a volcanic source: ash fallout, rain acidified by ash, and a plume. Furthermore, the Egypt described by the medical texts matches the one in the series of so-called biblical plagues. This match in turn provides the length of time, 19 months, between the initial and final phases of the eruption, each phase contributing to the otherwise odd accumulation of sulfates spread over two consecutive biennia (1603-1600 BC) in Greenland's ice core. As a result, the initial phase of the eruption can be dated to August 21, 1603 BC, and the final one to March 1601 BC, in full agreement with the radiocarbon data (1627-1600 BC) based on the outermost ring on the branch of an olive tree killed by the eruption.

背景与目标： ：埃及医学纸莎草画定于圣托里尼岛喷发，并调和了迄今为止考古/历史和科学数据之间的二分法。医学文档描述了疾病，这些疾病仅可能是由火山源引起的：灰烬沉淀，被灰烬酸化的雨水和烟羽。此外，医学文献所描述的埃及与一系列所谓的圣经瘟疫中的埃及相匹配。这场比赛反过来为喷发的初始阶段和最终阶段之间提供了19个月的时间长度，每个阶段都导致了格陵兰岛冰芯中连续两个两年期（公元前1603-1600年）散布着硫酸盐的否则奇怪的积累。结果，喷发的初始阶段可以追溯到公元前1603年8月21日，最后一次可以追溯到公元前1601年3月，这与基于分支最外环的放射性碳数据（1627-1600 BC）完全一致。被喷发杀死的一棵橄榄树。

BACKGROUND & AIMS: We report the response to risperidone in seven hospitalized, adult patients who presented psychotic symptoms etiologically related to a general medical condition. The conditions included brain surgery in two, and anticardiolipin syndrome, renal failure, epilepsy, lupus, and metastatic carcinoma in one each. Four patients had failed previous treatment with at least one typical antipsychotic agent. Response to risperidone was assessed by the Brief Psychiatric Rating Scale (BPRS). Serum was collected for measurement of steady-state trough risperidone and 9-hydroxyrisperidone concentrations at effective doses in three patients. Amelioration of psychotic symptoms was noted in all seven patients. Mean (+/- SD) BPRS scores were reduced significantly from baseline (63.0 +/- 15.1) to endpoint (27.0 +/- 3.5; p < 0.01). The mean effective daily dose of risperidone was 3.1 +/- .7 mg and time to response was 4.7 +/- 2.4 days. Risperidone was not present at detectable concentrations in the three patients studied. The mean steady-state trough serum concentration of 9-hydroxyrisperidone in the three patients assessed was 20.3 +/- 9.8 ng/ml. These preliminary findings, which suggest that risperidone is a safe and effective agent in patients with psychotic symptoms due to various medical conditions, need to be confirmed by randomized, antipsychotic comparison trials involving a larger number of patients.

背景与目标： 我们报告了七名住院的成年患者对利培酮的反应，这些患者在病因学上呈现出与一般医疗状况相关的精神病症状。这些疾病包括脑外科手术两次，抗心磷脂综合症，肾衰竭，癫痫，狼疮和转移性癌各一次。四名患者先前接受了至少一种典型的抗精神病药治疗失败。通过简要精神病评定量表（BPRS）评估对利培酮的反应。收集血清用于在三位患者中以有效剂量测量稳态谷色利培酮和9-羟基利培酮的浓度。在所有七名患者中均发现精神病症状得到改善。从基线（63.0 /-15.1）到终点（27.0 /-3.5； p <0.01），平均（±SD）BPRS得分显着降低。利培酮的平均有效日剂量为3.1 /-.7 mg，响应时间为4.7 /-2.4天。在研究的三位患者中，未检测到利培酮的存在。在评估的三名患者中，9-羟基利培酮的平均稳态谷浓度为20.3 /-9.8 ng / ml。这些初步发现表明，利培酮是因各种医疗条件而出现精神病症状的患者的安全有效药物，需要通过涉及更多患者的随机抗精神病药物比较试验来证实。

BACKGROUND & AIMS: :"First responders" are people trained in advanced first aid who can respond at the same time as, and often more quickly than, ambulance services to suspected medical emergencies. Hatzolah is a volunteer First Responder group, based on halakhic (Jewish legal) principles, in a localised area of metropolitan Melbourne with the highest density of Holocaust survivors outside Israel. Low numbers of "call-outs" to Victoria's Metropolitan Ambulance Service (MAS) from this community suggested that many were reluctant to make contact with a "uniformed" external agency. Hatzolah is an autonomous organisation operating under adapted MAS clinical practice guidelines and clinical governance processes. Hatzolah responders undergo an 18-month MAS training course comprising first aid, cardiopulmonary resuscitation, the use of semiautomated defibrillators, and oxygen therapy. We describe the first 11 years (1995-2005) of the Hatzolah service. The number of patients attended to annually has risen steadily, peaking at 867 in 2005. The most frequent reasons for call-outs were falls (19.4%), chest pain (9.7%), or respiratory distress (7.6%). Hatzolah's median response times were 2 or 3 min for all cases. They attended 35 patients with cardiac arrest (median response time, 2 min), and arrived before the MAS to 29 call-outs (83%). Nineteen patients (54%) with cardiac arrest were resuscitated and transported from the scene alive. Among those transported, significantly more had a shockable cardiac rhythm (50% v 13%, P = 0.03). Five (14%) survived to hospital discharge. Hatzolah has evolved into an organisation providing a complementary service to the MAS. It serves as a model for the establishment of other metropolitan community First Responder groups.

背景与目标： ：“急救人员”是受过高级急救训练的人员，可以与救护车服务同时对可疑医疗紧急情况做出响应，而且往往比救护车服务更快。哈佐拉（Hatzolah）是自愿响应的“第一响应者”团体，基于犹太人（犹太法律）原则，在墨尔本以外的以色列大屠杀幸存者密度最高的大都市墨尔本本地区域中。来自该社区的维多利亚大都会救护车服务（MAS）的“召集”次数很少，这表明许多人不愿与“统一”的外部机构进行联系。 Hatzolah是根据适应性MAS临床实践指南和临床治理流程运作的自治组织。 Hatzolah响应者接受为期18个月的MAS培训课程，包括急救，​​心肺复苏，半自动除颤器的使用和氧气疗法。我们描述了Hatzolah服务的前11年（1995-2005年）。每年看病的人数一直稳定增长，在2005年达到867例的峰值。最常见的原因是跌倒（19.4％），胸痛（9.7％）或呼吸窘迫（7.6％）。在所有情况下，Hatzolah的中位反应时间均为2或3分钟。他们治疗了35例心脏骤停的患者（中位反应时间为2分钟），并在MAS之前到达了29个呼出处（83％）。复苏了19例心脏骤停的患者（54％），并从现场转移了生命。在被转运的人中，明显的人具有令人震惊的心律（50％对13％，P = 0.03）。五（14％）人存活到医院出院。 Hatzolah已发展成为向MAS提供补充服务的组织。它是建立其他大都市社区“第一响应者”团体的典范。

BACKGROUND & AIMS: PURPOSE:There has been little radiation oncologist (RO)-specific research in continuing medical education (CME) or quality improvement (QI) program efficacy. Our aim was to evaluate a CME/QI program for changes in RO behavior, performance, and adherence to department protocols/studies over the first 12 months of the program. METHODS AND MATERIALS:The CME/QI program combined chart audit with feedback (C-AWF), simulation review AWF (SR-AWF), reminder checklists, and targeted CME tutorials. Between April 2003 and March 2004, management of 75 patients was evaluated by chart audit with feedback (C-AWF) and 178 patients via simulation review audit (SR-AWF) using a validated instrument. Scores were presented, and case management was discussed with individualized educational feedback. RO behavior and performance was compared over the first year of the program. RESULTS:Comparing the first and second 6 months, there was a significant improvement in mean behavior (12.7-13.6 of 14, p = 0.0005) and RO performance (7.6-7.9 of 8, p = 0.018) scores. Protocol/study adherence significantly improved from 90.3% to 96.6% (p = 0.005). A total of 50 actions were generated, including the identification of learning needs to direct CME tutorials, the systematic change of suboptimal RO practice, and the alteration of deficient management of 3% of patients audited during the program. CONCLUSION:An integrated CME/QI program combining C-AWF, SR-AWF, QI reminders, and targeted CME tutorials effectively improved targeted RO behavior and performance over a 12-month period. There was a corresponding increase in departmental protocol and study adherence.

背景与目标： 目的：在继续医学教育（CME）或质量改善（QI）计划功效方面，几乎没有针对放射肿瘤学家（RO）的研究。我们的目的是评估一个CME / QI计划，以了解该计划的前12个月RO行为，绩效以及对部门规约/研究的遵守情况的变化。
方法和材料：CME / QI程序将图表审核与反馈（C-AWF），模拟审阅AWF（SR-AWF），提醒清单和目标CME教程相结合。在2003年4月至2004年3月之间，使用经过验证的工具，通过带有反馈的图表审计（C-AWF）评估了75名患者的管理，通过模拟审查审计（SR-AWF）评估了178名患者的管理。提出分数，并通过个性化的教育反馈讨论案例管理。在该计划的第一年，对RO的行为和性能进行了比较。
结果：与前六个月和第二个六个月相比，平均行为（14.12.7-13.6，p = 0.0005）和反渗透表现（7.6-7.9，8，p = 0.018）有显着改善。方案/研究依从性从90.3％显着提高到96.6％（p = 0.005）。总共产生了50项行动，包括确定直接进行CME指导的学习需求，对次优RO实践的系统性改变以及在该计划中审核的3％的患者管理不善的变更。
结论：结合了C-AWF，SR-AWF，QI提示和目标CME教程的集成的CME / QI程序可以在12个月内有效改善目标RO的行为和性能。部门规程和研究依从性相应增加。

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: -2

背景与目标： -2

BACKGROUND & AIMS: OBJECTIVES:To examine the long-term relationships between costs, utilization, and patient-centered medical home (PCMH) clinical practice systems. STUDY DESIGN:Clinical practice systems were evaluated at baseline by the Physician Practice Connections-Research Survey (PPC-RS). Annual costs and utilization of a retrospectively constructed cohort of 58,391 persons receiving primary care at 1 of 22 medical groups over a 5-year period (2005-2009) were compared. METHODS:Multivariate regressions adjusting for patient demographics, health status, and autoregressive errors compared PPC-RS scores and study outcomes for the entire cohort and 3 subcohorts defined by medical complexity (medication count 0-2 [n = 29,657], 2-6 [n = 19,505], >7 [n = 9229]). Outcomes (adjusted to 2005 dollars) were total costs, outpatient costs, inpatient costs, inpatient days, and emergency department (ED) use. RESULTS:For the entire cohort, a 10% increase in PPC-RS scores was associated with 3.9 (medication count: 0-2), 6 (3-6), and 11.6 (>7) fewer ED visits per 1000 in 2005; and 5.1, 7.6, and 13.6 fewer ED visits in 2009. That 10% increase was not associated with the 0-2 medication subcohort's total (-$22/person in 2005; $184/person in 2009), outpatient (-$11/person in 2005; $42/person in 2009), or inpatient ($26/person in 2005; $29/person in 2009) costs. However, it was associated with significantly decreased total (-$446/person in 2005; -$184/person in 2009) and outpatient (-$241/person in 2005; -$54/person in 2009) costs for the most medically complex subcohort (>7 medications). CONCLUSIONS:Association of PCMH clinical practice systems with reduced costs appears limited to the most medically complex patients.

背景与目标： 目的：研究成本，使用率和以患者为中心的医疗之家（PCMH）临床实践系统之间的长期关系。
研究设计：临床实践系统是通过医师实践连接研究调查（PPC-RS）在基线进行评估的。比较了过去5年（2005-2009年）在22个医疗组中的1个接受初级保健的58,391人的回顾性构建队列的年度成本和使用情况。
方法：针对患者人口统计学，健康状况和自回归误差进行多元回归调整后，比较了整个队列和3个亚队列的PPC-RS评分和研究结果（由药物复杂性定义（药物计数0-2 [n = 29,657]，2-6 [ n = 19,505]，> 7 [n = 9229]）。结果（调整为2005年美元）为总费用，门诊费用，住院费用，住院天数和急诊科（ED）的使用。
结果：在整个队列中，2005年PPC-RS得分增加10％与3.9（用药计数：0-2），6（3-6）和11.6（> 7）ED访视次数减少相关；在2009年，急诊就诊次数减少了5.1、7.6和13.6。这增加了10％与0-2药物亚人群的总数（2005年为-$ 22 /人； 2009年为$ 184 /人），门诊患者（-$ 11 /人）无关。 2005年； 42美元/人，2009年）或住院（2005年26美元/人； 2009年29美元/人）费用。但是，这与医学上最复杂的亚人群的总费用（2005年为-446美元/人； 2009年为-184美元/人）和门诊费用（-2005年为-241美元/人； -2009年为54美元/人）显着降低有关（> 7种药物）。
结论：降低成本的PCMH临床实践系统的关联似乎仅限于大多数医学上复杂的患者。

BACKGROUND & AIMS: :Catalysing the reduction of oxygen in acidic media is a standing challenge. Although activity of platinum, the most active metal, can be substantially improved by alloying, alloy stability remains a concern. Here we report that platinum nanoparticles supported on graphite-rich boron carbide show a 50-100% increase in activity in acidic media and improved cycle stability compared to commercial carbon supported platinum nanoparticles. Transmission electron microscopy and x-ray absorption fine structure analysis confirm similar platinum nanoparticle shapes, sizes, lattice parameters, and cluster packing on both supports, while x-ray photoelectron and absorption spectroscopy demonstrate a change in electronic structure. This shows that purely electronic metal-support interactions can significantly improve oxygen reduction activity without inducing shape, alloying or strain effects and without compromising stability. Optimizing the electronic interaction between the catalyst and support is, therefore, a promising approach for advanced electrocatalysts where optimizing the catalytic nanoparticles themselves is constrained by other concerns.

背景与目标： ：在酸性介质中催化氧的还原是一项长期挑战。尽管可以通过合金化显着提高最活泼的金属铂的活性，但合金的稳定性仍然值得关注。在这里，我们报告说，与商业碳载铂纳米颗粒相比，负载在富含石墨的碳化硼上的铂纳米颗粒在酸性介质中的活性提高了50-100％，并且循环稳定性得到了改善。透射电子显微镜和X射线吸收精细结构分析证实了两种载体上相似的铂纳米颗粒形状，大小，晶格参数和簇堆积，而X射线光电子和吸收光谱表明电子结构发生了变化。这表明纯电子金属-载体相互作用可以显着改善氧还原活性，而不会引起形状，合金或应变效应，并且不会损害稳定性。因此，优化催化剂和载体之间的电子相互作用是用于高级电催化剂的有前途的方法，其中优化催化纳米颗粒本身受到其他问题的限制。

BACKGROUND & AIMS: BACKGROUND:The economic consequences of environmental tobacco smoke (ETS) have been simulated using models. We examined the individual-level association between ETS exposure and medical costs among Japanese nonsmoking women. METHODS:This population-based cohort study enrolled women aged 40 to 79 years living in a rural community. ETS exposure in homes at baseline was assessed with a self-administered questionnaire. We then collected health insurance claims data on direct medical expenditures from 1995 through 2007. Using generalized linear models with interaction between ETS exposure level and age stratum, average total monthly expenditure (inpatient plus outpatient care) per capita for nonsmoking women highly exposed and moderately exposed to ETS were compared with expenditures for unexposed women. We performed separate analyses for survivors and nonsurvivors. RESULTS:We analyzed data from 4870 women. After adjustment for potential confounding factors, survivors aged 70 to 79 who were highly exposed to ETS incurred higher expenditures than those who were not exposed. We found no significant difference in expenditures between moderately exposed and unexposed women. Total expenditures were not significantly associated with ETS exposure among survivors aged 40 to 69 or nonsurvivors of any age stratum. CONCLUSIONS:We calculated individual-level excess medical expenditures attributable to household exposure to ETS among surviving older women. The findings provide direct evidence of the economic burden of ETS, which is helpful for policymakers who seek to achieve the economically attractive goal of eliminating ETS.

背景与目标： 背景：使用模型模拟了环境烟草烟雾（ETS）的经济后果。我们研究了日本非吸烟女性中ETS暴露与医疗费用之间的个体关系。
方法：这项基于人群的队列研究纳入了居住在农村社区中的40至79岁的女性。使用自我管理的问卷评估基线时房屋中的ETS暴露。然后，我们收集了1995年至2007年间直接医疗支出的健康保险理赔数据。使用具有ETS暴露水平和年龄层次之间相互作用的广义线性模型，高度暴露和中度暴露的非吸烟女性的人均平均每月总支出（住院加门诊）将ETS与未接触妇女的支出进行比较。我们对幸存者和非幸存者分别进行了分析。
结果：我们分析了4870名女性的数据。在对潜在的混杂因素进行调整之后，70-79岁的幸存者与易受感染的人群相比，未受感染的人群的支出更高。我们发现中度暴露和未暴露的女性在支出上没有显着差异。总支出与40至69岁的幸存者或任何年龄层次的非幸存者中的ETS暴露没有显着相关。
结论：我们计算了幸存的老年妇女归因于家庭暴露于ETS的个人水平的超额医疗支出。调查结果直接证明了碳排放交易体系的经济负担，这对寻求实现消除碳排放交易体系的具有经济吸引力的目标的决策者很有帮助。

BACKGROUND & AIMS: :Human choline dehydrogenase (CHD) is located in the inner membrane of mitochondria primarily in liver and kidney and catalyzes the oxidation of choline to glycine betaine. Its physiological role is to regulate the concentrations of choline and glycine betaine in the blood and cells. Choline is important for regulation of gene expression, the biosynthesis of lipoproteins and membrane phospholipids and for the biosynthesis of the neurotransmitter acetylcholine; glycine betaine plays important roles as a primary intracellular osmoprotectant and as methyl donor for the biosynthesis of methionine from homocysteine, a required step for the synthesis of the ubiquitous methyl donor S-adenosyl methionine. Recently, CHD has generated considerable medical attention due to its association with various human pathologies, including male infertility, homocysteinuria, breast cancer and metabolic syndrome. Despite the renewed interest, the biochemical characterization of the enzyme has lagged behind due to difficulties in the obtainment of purified, active and stable enzyme. This review article summarizes the medical relevance and the physiological roles of human CHD, highlights the biochemical knowledge on the enzyme, and provides an analysis based on the comparison of the protein sequence with that of bacterial choline oxidase, for which structural and biochemical information is available.

背景与目标： 人胆碱脱氢酶（CHD）位于线粒体内膜中，主要位于肝脏和肾脏中，并催化胆碱氧化为甘氨酸甜菜碱。它的生理作用是调节血液和细胞中胆碱和甘氨酸甜菜碱的浓度。胆碱对调节基因表达，脂蛋​​白和膜磷脂的生物合成以及神经递质乙酰胆碱的生物合成很重要。甘氨酸甜菜碱起着重要的细胞内渗透保护剂的作用，并作为高半胱氨酸生物合成蛋氨酸的甲基供体，这是合成无处不在的甲基供体S-腺苷蛋氨酸的必需步骤。最近，由于冠心病与各种人类疾病相关，包括男性不育症，高半胱氨酸尿症，乳腺癌和代谢综合征，已经引起了广泛的医学关注。尽管重新获得了兴趣，但是由于难以获得纯化的，活性的和稳定的酶，所以该酶的生物化学表征已经落后。这篇综述文章总结了人类冠心病的医学意义和生理作用，着重介绍了该酶的生化知识，并在比较蛋白质序列和细菌胆碱氧化酶序列的基础上，提供了分析，并提供了结构和生化信息。 。

BACKGROUND & AIMS: OBJECTIVE:To describe the timing of cardiac arrest detection in relation to episodes of Medical Emergency Team (MET) review and routine nursing observations. DESIGN AND SETTING:Retrospective observational study in a university-affiliated hospital. PATIENTS:279 cardiac arrests involving ward patients MEASUREMENTS AND RESULTS:Cardiac arrests were allocated to one of 24 1-h intervals (24:00-00:59, 01:00-01:59, etc.). The actual hourly rate of cardiac arrests was related to the expected average hourly rate. Peak levels of cardiac arrest detection occurred during times of routine overnight nursing clinical observations between 02:00 and 03:00 (OR 3.06) and 06:00-07:00 (OR 1.95). The lowest level of cardiac arrest detection occurred between 20:00 and 21:00 (OR 0.42). After introduction of the MET there were 162 cardiac arrests, 28% of which occurred shortly after an initial MET call. The odds ratio for risk of cardiac arrest during periods of lowest MET activation (24:00-08:00) when compared with periods of highest MET activation (16:00-24:00) was 2.26. CONCLUSIONS:Cardiac arrest detection in our hospital is episodic with peak levels corresponding to periods of overnight routine nursing observations following a period when patient review is likely to be low. After the introduction of the MET there was an inverse link between detection of cardiac arrests and levels of MET activation over the 24-h period. Increased overnight utilization and earlier MET activation may further reduce the incidence of cardiac arrests at our hospital.

背景与目标： 目的：描述与医疗急救小组（MET）复查和常规护理观察有关的心脏骤停检测的时机。
设计与地点：某大学附属医院的回顾性观察研究。
患者：病房患者发生279次心脏骤停
测量和结果：将心脏骤停分配给24个1小时间隔中的一个（24：00-00：59、01：00-01：59等）。心脏骤停的实际每小时速率与预期的平均每小时速率相关。在常规的隔夜护理临床观察期间，发生心脏骤停检测的峰值水平是在02:00至03:00（OR 3.06）和06：00-07：00（OR 1.95）之间。最低的心脏骤停检测发生在20:00和21:00之间（或0.42）。引入MET后，发生了162次心脏骤停，其中28％发生在首次MET呼叫后不久。与最低MET激活时间段（16：00-24：00）相比，最低MET激活时间段（24：00-08：00）发生心脏骤停的风险比值比为2.26。
结论：我们医院的心脏骤停检测是偶发性的，其峰值水平对应于患者复查可能很低的时期后的隔夜常规护理观察的时期。引入MET后，在24小时内，心脏骤停的检测与MET激活水平之间存在反比关系。过夜使用率的提高和MET的早期激活可能会进一步减少我们医院心脏骤停的发生率。