• 【经腋窝入路无气内镜甲状腺切除术:经验30例。】 复制标题 收藏 收藏
    DOI:10.1097/00129689-200608000-00006 复制DOI
    作者列表:Yoon JH,Park CH,Chung WY
    BACKGROUND & AIMS: :Surgery for thyroid disease requires skin incisions that can result in postsurgical problems such as prominent scars, adhesions, hypesthesia, and paresthesia in the neck. To overcome these problems we performed gasless endoscopic thyroidectomy via an axillary approach. Between May 2004 and April 2005, 30 patients underwent gasless endoscopic thyroidectomy via an axillary approach. The mean operating time was 126.8+/-32.4 minutes, and the mean length of hospital stay was 4.3+/-1.1 days. No cases required conversion to open surgery and none involved significant intraoperative complications. Three patients (10.0%) complained of slight hypesthesia or paresthesia in the anterior chest wall, and only 2 patients (6.7%) complained of discomfort while swallowing 4 months after surgery. All patients were satisfied with the cosmetic results. Gasless endoscopic thyroidectomy via an axillary approach is feasible and safe and provides excellent cosmetic results with a minimal degree of postoperative complaints.
    背景与目标: :甲状腺疾病的手术需要皮肤切口,这可能导致术后问题,例如明显的疤痕,粘连,感觉异常和颈部感觉异常。为了克服这些问题,我们通过腋窝入路进行了无气内镜甲状腺切除术。在2004年5月至2005年4月之间,有30例患者通过腋窝入路行无气内镜甲状腺切除术。平均手术时间为126.8 /-32.4分钟,平均住院时间为4.3 /-1.1天。没有病例需要转换为开放手术,也没有涉及重大的术中并发症。 3例患者(10.0%)抱怨前胸壁轻度感觉异常或感觉异常,而只有2例患者(6.7%)吞咽术后4个月吞咽不适。所有患者对美容效果均满意。通过腋窝入路的无气内镜甲状腺切除术是可行且安全的,并能以极少的术后不适程度提供出色的美容效果。
  • 【白色念珠菌myristoylCoA的选择性肽和拟肽抑制剂:蛋白N-肉豆蔻酰基转移酶:一种抗真菌治疗的新方法。】 复制标题 收藏 收藏
    DOI:10.1002/(SICI)1097-0282(1997)43:1<43::AID-BIP5>3.0 复制DOI
    作者列表:Sikorski JA,Devadas B,Zupec ME,Freeman SK,Brown DL,Lu HF,Nagarajan S,Mehta PP,Wade AC,Kishore NS,Bryant ML,Getman DP,McWherter CA,Gordon JI
    BACKGROUND & AIMS: MyristoylCoA:protein N-myristoyltransferase (NMT) catalyzes the cotranslational covalent attachment of a rare cellular fatty acid, myristate, to the N-terminal Gly residue of a variety of eukaryotic proteins. The myristoyl moiety is often essential for expression of the biological functions for these proteins.

    Attachment of C14:0 alone provides barely enough hydrophobicity to allow stable association with membranes. The partitioning of N-myrisotylproteins is therefore often modulated by "switches" that function through additional covalent or noncovalent modifications. Candida albicans, the principal cause of systemic fungal infection in immunocompromised humans, contains a single NMT gene that is essential for its viability. The functional properties of the acylCoA binding site of human and C. albicans NMT are very similar. However, there are distinct differences in their peptide binding sites. An ADP ribosylation factor (Arf) is included among the few cellular protein substrates of the fungal enzyme. Alanine scanning mutagenesis of an octapeptide derived from an N-terminal Arf sequence (GLYASKLS-NH2) disclosed that Gly1, Ser5, and Lys6 play predominant roles in binding. ALYASKLS-NH2 is an inhibitor competitive for peptide [Ki(app) = 15.3 +/- 6.4 microM] and noncompetitive for myristoylCoA. Remarkably, replacement of the N-terminal tetrapeptide with an 11-aminoundecanoyl group results in a competitive inhibitor (11-aminoundecanoyl-SKLS-NH2) that is approximately 40-fold more potent [Ki(app) = 0.40 +/- 0.03 microM] than the starting octapeptide. Removal of Leu-Ser from the C-terminus generates a competitive dipeptide inhibitor (11-aminoundecanoyl-SK-NH2) with a Ki(app) of 11.7 +/- 0.4 microM, equivalent to that of the starting octapeptide. A derivative dipeptide inhibitor containing a C-terminal N-cyclohexylethyl lysinamide moiety has the advantage of being more potent (IC50 = 0.11 +/- 0.03 microM) and resistant to digestion by cellular carboxypeptidases. Rigidifying the flexible aminoundecanoyl chain results in very potent general NMT inhibitors (IC50 = 40-50 nM). Substituting a 2-methylimidazole for the N-terminal amine and adding a benzylic alpha-methyl group with R stereochemistry to the rigidifying element produces even more potent inhibitors (IC50 = 20-50 nM) that are up to 500-fold selective for the fungal compared to human enzyme. A related less potent member of this series of compounds is fungistatic. Its growth inhibitory effects are associated with a reduction in cellular protein N-myristoylation, judged using cellular Arf as a reporter. These studies establish that NMT is a new antifungal target.

    背景与目标: MyristoylCoA :蛋白N-肉豆蔻酰基转移酶(NMT)催化稀有细胞脂肪酸肉豆蔻酸酯与多种真核蛋白N-末端Gly残基的共翻译共价连接。肉豆蔻酰基部分通常对于表达这些蛋白质的生物学功能是必不可少的。

    C14 :0的附着本身仅提供了不足以使与膜稳定结合的疏水性。因此,N-肉豆蔻酰蛋白的分区通常由通过附加的共价或非共价修饰起作用的“开关”调节。白色念珠菌是免疫功能低下的人体内全身真菌感染的主要原因,它含有一个对其生存能力至关重要的单个NMT基因。人和白色念珠菌NMT的酰基辅酶A结合位点的功能特性非常相似。但是,它们的肽结合位点存在明显差异。 ADP核糖基化因子(Arf)包括在真菌酶的几种细胞蛋白底物中。来自N末端Arf序列(GLYASKLS-NH2)的八肽的丙氨酸扫描诱变显示,Gly1,Ser5和Lys6在结合中起主要作用。 ALYASKLS-NH2是一种对肽[Ki(app)= 15.3 /-6.4 microM]具有竞争性的抑制剂,对肉豆蔻酰辅酶A不具有竞争性。值得注意的是,用11-氨基十一烷酰基取代N末端四肽会产生竞争性抑制剂(11-氨基十一烷酰基-SKLS-NH2),其效力比[Ki(app)= 0.40 /-0.03 microM]高40倍左右。起始八肽。从C末端去除Leu-Ser会产生竞争性的二肽抑制剂(11-氨基十一烷酰基-SK-NH2),Ki(app)为11.7 /-0.4 microM,与起始八肽相当。含有C-末端N-环己基乙基赖氨酰胺部分的衍生物二肽抑制剂具有更有效的优势(IC 50 = 0.11 /0.03μM),并且对细胞羧肽酶的消化具有抵抗力。刚性化柔性氨基十一烷酰基链会产生非常有效的常规NMT抑制剂(IC50 = 40-50 nM)。用2-甲基咪唑取代N端胺,并在刚性元素中添加具有R立体化学的苄基α-甲基,可产生更强效的抑制剂(IC50 = 20-50 nM),对真菌的选择性高达500倍与人类酶相比。该系列化合物的一个相关的效力较弱的成员是抑真菌的。使用细胞Arf作为报告基因判断,其生长抑制作用与细胞蛋白N-肉豆蔻酰化的减少有关。这些研究确定NMT是一种新的抗真菌靶标。

  • 【勘误表“生物碱与DNA的结合:光物理和量热法” [J.光化学。感光油。 B:生物学。 130(2014)272-280]。】 复制标题 收藏 收藏
    DOI:10.1016/j.jphotobiol.2015.03.003 复制DOI
    作者列表:Sarkar S,Bhadra K
    BACKGROUND & AIMS: -2
    背景与目标: -2
  • 【当地卫生部门对儿童肥胖症进行监测的协作方法。】 复制标题 收藏 收藏
    DOI:10.1097/PHH.0000000000000615 复制DOI
    作者列表:Alleman E,Murphy E,Baskerville K,Chugh R
    BACKGROUND & AIMS: :DuPage County Health Department collected de-identified data from health forms submitted by participating schools for academic years 2011-2015 for kindergarten, sixth-, and ninth-grade students to determine the prevalence of obesity and elevated blood pressure among public school students. The prevalence of obesity in students for the 2014-2015 school year was 15.1%, and the prevalence of elevated blood pressure was 22.8%. Students in the "obese" body mass index percentile category had an elevated blood pressure prevalence of 44.2%, which was higher than students in the "nonobese" category (P < .001). Significant differences were also observed both by sex and by grade. The results identify the need to support implementation and evaluation of policies to reduce childhood obesity and improve health outcomes. By partnering with schools to obtain preexisting health data, state or local health departments with limited resources may replicate these methods to develop a childhood obesity surveillance system.
    背景与目标: :DuPage县卫生部门从参与学校提交的2011-2015学年的健康表格中收集了针对幼儿园,六年级和九年级学生的身份数据,以确定公立学校学生中肥胖症和高血压的患病率。 2014-2015学年,学生的肥胖症患病率为15.1%,高血压病患病率为22.8%。体重指数为“肥胖”类别的学生的血压患病率升高为44.2%,高于“非肥胖”类别的学生(P <.001)。在性别和年级方面也观察到显着差异。结果表明,有必要支持实施和评估减少儿童肥胖和改善健康结果的政策。通过与学校合作以获取预先存在的健康数据,资源有限的州或地方卫生部门可以复制这些方法来开发儿童肥胖症监测系统。
  • 【αC螺旋置换是蛋白激酶变构调节的一般方法。】 复制标题 收藏 收藏
    DOI:10.1016/j.drudis.2012.11.009 复制DOI
    作者列表:Palmieri L,Rastelli G
    BACKGROUND & AIMS: :Owing to their crucial role in the modulation of cell pathways, protein kinases are important targets for several human diseases, including but not limited to cancer. The classic approach of targeting the ATP active site has recently come up against selectivity issues, which can be considerably reduced by following an allosteric modulation approach. Being closely related to protein kinase inactivation, allosteric targeting via displacement of the conserved structural αC helix enables a direct and specific modulation mechanism. A structure-based survey of the allosteric regulation of αC helix conformation in various kinase families is provided, highlighting key allosteric pockets and modulation mechanisms that appear to be more broadly conserved than was previously thought.
    背景与目标: 蛋白激酶由于其在调节细胞途径中的关键作用,因此成为多种人类疾病(包括但不限于癌症)的重要靶标。靶向ATP活性位点的经典方法最近遇到了选择性问题,通过采用变构调节方法可以大大降低选择性。与蛋白激酶失活密切相关,通过置换保守结构αC螺旋的变构靶向可实现直接和特异性的调节机制。提供了对各种激酶家族中αC螺旋构象的变构调节的基于结构的调查,着重指出了关键的变构口袋和调节机制,它们似乎比以前认为的更为保守。
  • 【降低ST段抬高型心肌梗死的手术过程死亡率和of骨入路出血率。倾向得分分析来自ORPKI波兰国家注册局的数据。】 复制标题 收藏 收藏
    DOI:10.4244/EIJ-D-17-00078 复制DOI
    作者列表:Siudak Z,Tokarek T,Dziewierz A,Wysocki T,Wiktorowicz A,Legutko J,Żmudka K,Dudek D
    BACKGROUND & AIMS: AIMS:We sought to evaluate bleeding complications and periprocedural outcomes of the radial approach (RA) as compared to the femoral approach (FA) during percutaneous coronary intervention (PCI) in "real-world" patients with ST-segment elevation myocardial infarction (STEMI). METHODS AND RESULTS:The study group consisted of 22,812 consecutive patients with STEMI treated with PCI and stent implantation between January 2014 and June 2015 in 151 tertiary invasive cardiology centres in Poland (the ORPKI Polish National Registry). Patients treated using the RA and FA were compared using a propensity score analysis to avoid possible selection bias. The analysis was carried out in an "as-treated" manner. The FA was used in 9,334 (40.9%) and the RA in 13,478 (59.1%) patients. After propensity score matching, a higher total amount of contrast (191.8±8.0 vs. 174.8±68.8 ml; p=0.001) and lower radiation doses (1,279.5±1,346.3 vs. 1,182.6±887 mGy; p=0.02) were reported in FA. More access-site-related bleeding complications after both angiography (0.17% vs. 0.02%; p=0.004) and PCI (0.23% vs. 0.09%; p=0.049) were reported in the FA group. Periprocedural death (1.94% vs. 0.93%; p=0.001) was more common after PCI performed with the FA. CONCLUSIONS:The radial approach was associated with a lower incidence of periprocedural death in STEMI patients as well as a significant reduction of bleeding complications at the access site.
    背景与目标: 目的:我们试图评估“现实” ST段抬高型心肌梗死(STEMI)患者在经皮冠状动脉介入治疗(PCI)期间与股动脉入路(FA)相比,radial动脉入路(RA)的出血并发症和围手术期结局)。
    方法与结果:该研究小组于2014年1月至2015年6月在波兰的151个三级侵入性心脏病学中心(ORPKI波兰国家注册中心)对22,812例连续的STEMI患者进行了PCI和支架植入治疗。使用倾向评分分析比较使用RA和FA治疗的患者,以避免可能的选择偏倚。该分析以“处理后”的方式进行。 FA用于9,334(40.9%),RA用于13,478(59.1%)患者。倾向得分匹配后,FA中的造影剂总量较高(191.8±8.0 vs. 174.8±68.8 ml; p = 0.001)和较低的放射剂量(1,279.5±1,346.3 vs.1,182.6±887 mGy; p = 0.02)。在FA组中,血管造影后(0.17%vs. 0.02%; p = 0.004)和PCI(0.23%vs. 0.09%; p = 0.049)出现更多的与出入部位相关的出血并发症。在FA进行PCI后,围手术期死亡(1.94%vs. 0.93%; p = 0.001)更为常见。
    结论:radial动脉入路与STEMI患者围手术期死亡的发生率较低,以及进入部位出血并发症的发生率显着降低有关。
  • 【双底物酰基转移酶反应的稳态动力学的理论方法,该反应遵循基于可水解酰基酶的机制。在溶血磷脂酰胆碱研究中的应用:来自阿拉伯的溶血磷脂酰胆碱酰基转移酶】 复制标题 收藏 收藏
    DOI:10.1042/bj2660047 复制DOI
    作者列表:Martín J,Pérez-Gil J,Acebal C,Arche R
    BACKGROUND & AIMS: :A kinetic model is proposed for catalysis by an enzyme that has several special characteristics: (i) it catalyses an acyl-transfer bi-substrate reaction between two identical molecules of substrate, (ii) the substrate is an amphiphilic molecule that can be present in two physical forms, namely monomers and micelles, and (iii) the reaction progresses through an acyl-enzyme-based mechanism and the covalent intermediate can react also with water to yield a secondary hydrolytic reaction. The theoretical kinetic equations for both reactions were deduced according to steady-state assumptions and the theoretical plots were predicted. The experimental kinetics of lysophosphatidylcholine:lysophosphatidylcholine acyltransferase from rabbit lung fitted the proposed equations with great accuracy. Also, kinetics of inhibition by products behaved as expected. It was concluded that the competition between two nucleophiles for the covalent acyl-enzyme intermediate, and not a different enzyme action depending on the physical state of the substrate, is responsible for the differences in kinetic pattern for the two activities of the enzyme. This conclusion, together with the fact that the kinetic equation for the transacylation is quadratic, generates a 'hysteretic' pattern that can provide the basis of self-regulatory properties for enzymes to which this model could be applied.
    背景与目标: 提出了一种具有多种特殊特性的酶催化动力学模型:(i)催化两个相同底物分子之间的酰基转移双底物反应,(ii)底物是可以存在的两亲分子以两种物理形式(即单体和胶束)存在,并且(iii)反应通过基于酰基酶的机理进行,并且共价中间体也可以与水反应以产生二次水解反应。根据稳态假设推导了两个反应的理论动力学方程,并预测了理论图。来自兔肺的溶血磷脂酰胆碱:溶血磷脂酰胆碱酰基转移酶的实验动力学非常符合所提出的方程。同样,产物的抑制动力学表现也符合预期。结论是,两个亲核试剂之间对共价酰基酶中间体的竞争,而不是取决于底物的物理状态的不同酶作用,是造成酶两种活性动力学模式差异的原因。该结论,加上用于转酰化反应的动力学方程是二次方的事实,产生了一种“滞后”模式,该模式可以为可应用该模型的酶提供自我调节特性的基础。
  • 【大型草食动物的纤维消化率与消化类型和体重有关-一种体外方法。】 复制标题 收藏 收藏
    DOI:10.1016/j.cbpa.2012.10.026 复制DOI
    作者列表:Steuer P,Südekum KH,Müller DW,Kaandorp J,Clauss M,Hummel J
    BACKGROUND & AIMS: :The coexistence of different ungulate species in a given ecosystem has been the focus of many studies. Differences between ruminant foregut fermenters and hindgut fermenters were remarkable for example in the way they ingest and digest high fibre diets. Digestion trials based on total collections are difficult to conduct or are sometimes even not possible for wild animals in the field or in zoos. To gain information on the fibre digestion achieved by these animals and the influence of body mass (BM) thereon, a method using spot sampling is desirable. In this study, in vitro fermentation of faecal neutral detergent fibre (NDF) was used as a measure of fibre digestion in large ungulates. Food and faecal samples of 10 ruminant foregut fermenting and 7 hindgut fermenting species/breeds were collected. All animals received 100% grass hay with ad libitum access. The NDF of food and faeces was fermented in vitro in a Hohenheim gas test (HGT) for 96 h. The digestion type generally had an effect on the gas production (GP) of faecal NDF in the HGT with hindgut fermenters showing higher values than ruminant foregut fermenters. At any time interval of incubation, BM had no influence on GP. The results are in accordance with both findings that ruminant foregut fermenters have longer mean retention times and more comprehensive particle reduction and findings of a lack of influence of BM on digesta mean retention time. It can be stated that the HGT (96 h) is a useful and quick method to show also small differences within groups in fibre digestion.
    背景与目标: 在一个给定的生态系统中,有蹄类动物的共存一直是许多研究的重点。反刍动物前肠发酵罐和后肠发酵罐之间的差异非常明显,例如,它们摄取和消化高纤维饮食的方式不同。基于总收集物的消化试验很难进行,有时甚至对于野外或动物园中的野生动物也无法进行。为了获得有关这些动物实现的纤维消化及其体重(BM)的影响的信息,需要一种使用点采样的方法。在这项研究中,粪便中性洗涤剂纤维(NDF)的体外发酵被用作大有蹄类动物中纤维消化的量度。收集了10种反刍动物前肠发酵食品和7种后肠发酵物种/品种的食物和粪便样本。所有动物均自由采食100%干草。食物和粪便的NDF在Hohenheim气体试验(HGT)中进行了96 h的体外发酵。消化类型通常会对HGT中粪便NDF的产气量(GP)产生影响,其中后肠发酵罐的值要高于反刍动物前肠发酵罐的值。在任何孵育时间间隔,BM对GP均无影响。结果与两个发现均一致:反刍动物前肠发酵罐具有更长的平均保留时间和更全面的颗粒减少,并且发现BM对消化物的平均保留时间缺乏影响。可以说,HGT(96 h)是一种有用且快速的方法,可以显示纤维消化组内的细微差异。
  • 【减轻可卡因对细胞外多巴胺影响的直接方法:靶向多巴胺转运蛋白。】 复制标题 收藏 收藏
    DOI:10.1002/(SICI)1098-2396(199708)26:4<423::AID-SYN10 复制DOI
    作者列表:Morgan AE,Porter SP,Clarkson FA,Volkow ND,Fowler JS,Dewey SL
    BACKGROUND & AIMS: Using in vivo microdialysis techniques, the effects of RTI-55 and/or cocaine on extracellular dopamine (DA) concentrations were measured in the nucleus accumbens (NACC) of freely moving rats. In control animals, cocaine (20 mg/kg) increased NACC DA approximately 458% 60 minutes following administration, returning to baseline values within 200 minutes. Similarly, RTI-55 administration (0.25 mg/kg) increased NACC DA levels approximately 347%. When combined, however, cocaine further increased NACC DA to 705% of baseline values when given 4 hours following RTI-55. This increase was significantly larger than cocaine alone (P < 0.05). In addition, chronic RTI-55 administration (5 days) further potentiated cocaine's ability to increase NACC DA (783%) but this did not reach statistical significance (P > 0.1) compared to acute RTI55/cocaine animals. These findings indicate that RTI-55, a drug that binds directly to the dopamine transporter (DAT) with higher affinity than cocaine, does not appear to be effective in attenuating cocaine's effects on NACC dopamine levels. In fact, acute RTI-55 potentiates cocaine's effects on NACC DA.

    背景与目标: 使用体内微透析技术,在自由移动的大鼠伏伏核(NACC)中测量了RTI-55和/或可卡因对细胞外多巴胺(DA)浓度的影响。在对照动物中,可卡因(20 mg / kg)在给药60分钟后可使NACC DA升高约458%,在200分钟内恢复至基线值。同样,RTI-55的给药(0.25 mg / kg)使NACC DA水平升高约347%。但是,当联合使用时,可卡因在RTI-55后4小时给予时,NACC DA进一步增加至基线值的705%。这一增加比单独使用可卡因要大得多(P <0.05)。此外,长期RTI-55给药(5天)进一步增强了可卡因增加NACC DA的能力(783%),但与急性RTI55 /可卡因动物相比,这没有统计学意义(P> 0.1)。这些发现表明,RTI-55是一种比可卡因具有更高亲和力的直接结合多巴胺转运蛋白(DAT)的药物,在减轻可卡因对NACC多巴胺水平的影响方面似乎并不有效。实际上,急性RTI-55增强了可卡因对NACC DA的作用。

  • 10 Dengue vaccines approach the finish line. 复制标题 收藏 收藏

    【登革热疫苗已接近终点线。】 复制标题 收藏 收藏
    DOI:10.1086/518148 复制DOI
    作者列表:Edelman R
    BACKGROUND & AIMS: :The spread of dengue virus (DV) via its Aedes mosquito vector throughout most of the tropics has led to a worldwide resurgence of epidemic dengue, including dengue hemorrhagic fever. For the first time in 60 years, the pipeline of dengue vaccines looks promising. Strains of each of the 4 DV serotypes, attenuated by passage in tissue culture or by recombinant DNA technology, have been formulated into tetravalent vaccines and have entered successful phase 1 and 2 clinical trials in the United States and Southeast Asia. Antibody-dependent enhancement of wild-type DV infections by the vaccine represents a unique safety issue, which is under investigation. The Pediatric Dengue Vaccine Initiative (funded by the Bill and Melinda Gates Foundation), the World Health Organization, industry, the US military, and governments of tropical countries are collaborating to accelerate dengue vaccine development and phase 3 vaccine efficacy trials in countries where dengue is endemic. A protective tetravalent vaccine must be licensed soon if dengue is to be brought under control.
    背景与目标: :登革热病毒(DV)通过其伊蚊(Aedes)蚊子传播到整个热带大部分地区,导致登革热在全球范围内重新流行,包括登革热出血热。 60年来,登革热疫苗的首次面世前景看好。通过在组织培养中传代或通过重组DNA技术减毒的4种DV血清型中的每一种菌株已配制成四价疫苗,并已在美国和东南亚成功进入1和2期临床试验。疫苗对野生型DV感染的抗体依赖性增强代表了一个独特的安全问题,正在研究中。儿科登革热疫苗行动计划(由比尔和梅琳达·盖茨基金会资助),世界卫生组织,工业界,美国军方和热带国家政府正在合作,以加快登革热所在国家的登革热疫苗开发和3期疫苗功效试验地方性的。如果要控制登革热,必须尽快获得保护性四价疫苗的许可。
  • 【通过参与式行动研究方法研究中风后社区生活和参与的障碍和支持。】 复制标题 收藏 收藏
    DOI:10.1310/5X2G-V1Y1-TBK7-Q27E 复制DOI
    作者列表:Hammel J,Jones R,Gossett A,Morgan E
    BACKGROUND & AIMS: :This participatory action research study focused on identifying community participation goals, barriers, and supports/strategies in partnership with people who have experienced a stroke. Goals demonstrate that participation is more than activity performance in context; instead, it relates to "being a part of" the community and having access to participation opportunities and supports. Results of community site audits from the first 20 participants document environmental (physical, cognitive, social) and system level barriers, as well as effective strategies for promoting participation via environmental modification and systems level changes. A consumer-directed, Web-based tool for documenting participation barriers and sharing strategies is discussed.
    背景与目标: :这项参与式行动研究重点在于确定与中风患者合作的社区参与目标,障碍和支持/策略。目标表明,参与不仅仅是活动在上下文中的表现;相反,它涉及“成为社区的一部分”并获得参与机会和支持。前20名参与者进行的社区站点审核结果记录了环境(物理,认知,社会)和系统级别的障碍,以及通过环境修改和系统级别更改来促进参与的有效策略。讨论了一种面向消费者的,基于Web的工具,用于记录参与障碍和共享策略。
  • 【一种自由市场的比赛方法:尚未到来的提议。】 复制标题 收藏 收藏
    DOI:10.1097/ACM.0000000000001782 复制DOI
    作者列表:Arnold L,Sullivan C,Okah FA
    BACKGROUND & AIMS: :The authors respond to a proposal in this issue of Academic Medicine by Ray, Bishop, and Dow, who recommend adopting a free-market approach to the Match in which applicants and programs negotiate directly with each other to find and fill residency positions year-round. This Invited Commentary examines and responds to the reasons Ray and colleagues give for changing the Match and explores their proposal's implications and likelihood of success.The authors question Ray and colleagues' argument that assumptions underlying the National Resident Matching Program algorithm have been violated. The authors suggest there is insufficient evidence for the "July effect" and that the possibility for improvement in physician supply due to the year-round entry of graduates into the workforce ultimately faces the rate-limiting step of caps on residency positions allocated to programs. Most important, competency-based medical education, on which the free-market proposal depends, is not yet sufficiently developed.Nonetheless, the imbalanced ratio of applicants to positions in the Match is contributing to a rise in the numbers of student applications and program interviews. Although the proposed free-market approach might, as Ray and colleagues envision, curtail applications as well as reduce time and financial resources currently expended on the process, it would require significant changes on the part of applicants, residency programs, medical schools, and other stakeholders.Because the proposed free-market approach could reduce some negative effects of the imbalance of applicants and positions, it merits ongoing discussion along with other more immediate practical solutions to issues with the Match.
    背景与目标: :作者回应了Ray,Bishop和Dow在本期《学术医学》中提出的建议,他们建议对比赛采用自由市场的方法,在这种方法中,申请人和计划彼此直接协商以寻找并填补当年的居留职位-圆形的。本受邀评论对Ray和同事提出的更改比赛的原因进行了调查并做出回应,并探讨了其提议的含义和成功的可能性。作者质疑Ray和同事的论点,即违反了《美国国家居民匹配计划》算法的假设。作者认为,“七月效应”没有足够的证据,而且由于毕业生全年进入劳动力队伍而改善医生供应的可能性最终面临着分配给计划的居留职位上限的限速步骤。最重要的是,基于自由市场的建议所依赖的基于能力的医学教育尚未得到充分发展,尽管如此,申请人与比赛中职位的比例失衡导致学生申请和计划面试的人数增加。尽管如雷及其同事所设想的那样,提议的自由市场方法可能会减少申请,并减少目前在该过程中花费的时间和财务资源,但仍需要对申请人,居住计划,医学院和其他方面进行重大更改。由于拟议的自由市场方法可以减少申请人和职位失衡的某些负面影响,因此值得进行中的讨论以及针对Match问题的其他更直接的实际解决方案。
  • 【为原住民卫生人员确定适合文化的多层次戒烟策略:一种概念图方法。】 复制标题 收藏 收藏
    DOI:10.1093/her/cys111 复制DOI
    作者列表:Dawson AP,Cargo M,Stewart H,Chong A,Daniel M
    BACKGROUND & AIMS: :Aboriginal Australians, including Aboriginal Health Workers (AHWs), smoke at rates double the non-Aboriginal population. This study utilized concept mapping methodology to identify and prioritize culturally relevant strategies to promote smoking cessation in AHWs. Stakeholder participants included AHWs, other health service employees and tobacco control personnel. Smoking cessation strategies (n = 74) were brainstormed using 34 interviews, 3 focus groups and a stakeholder workshop. Stakeholders sorted strategies into meaningful groups and rated them on perceived importance and feasibility. A concept map was developed using multi-dimensional scaling and hierarchical cluster analyses. Ten unique clusters of smoking cessation strategies were depicted that targeted individuals, family and peers, community, workplace and public policy. Smoking cessation resources and services were represented in addition to broader strategies addressing social and environmental stressors that perpetuate smoking and make quitting difficult. The perceived importance and feasibility of clusters were rated differently by participants working in health services that were government-coordinated compared with community-controlled. For health service workers within vulnerable populations, these findings clearly implicate a need for contextualized strategies that mitigate social and environmental stressors in addition to conventional strategies for tobacco control. The concept map is being applied in knowledge translation to guide development of smoking cessation programs for AHWs.
    背景与目标: :包括澳大利亚原住民卫生工作者(AHWs)在内的澳大利亚原住民吸烟率是非原住民人口的两倍。这项研究利用概念图方法论来确定和优先考虑与文化相关的策略,以促进AHW中的戒烟。利益相关者的参与者包括AHW,其他卫生服务员工和烟草控制人员。通过34次访谈,3个焦点小组和一个利益相关者研讨会,集体讨论了戒烟策略(n = 74)。利益相关者将策略分为有意义的组,并根据感知到的重要性和可行性对它们进行评级。使用多维缩放和层次聚类分析开发了概念图。描绘了十个独特的戒烟策略组,这些策略针对个人,家庭和同龄人,社区,工作场所和公共政策。除更广泛的策略解决了使吸烟永久化和使戒烟困难的社会和环境压力外,还代表了戒烟资源和服务。在政府协调的卫生服务机构与社区控制的卫生服务机构中,参与者对集群的重要性和可行性的看法有所不同。对于脆弱人群中的卫生服务工作者,这些发现显然暗示着除了传统的烟草控制策略外,还需要有针对性的策略来减轻社会和环境压力。概念图已应用于知识翻译中,以指导针对AHW的戒烟计划的开发。
  • 【针对慢性气患者的基于办公室的简单行为方法。】 复制标题 收藏 收藏
    DOI:10.1111/dote.12006 复制DOI
    作者列表:Katzka DA
    BACKGROUND & AIMS: :Chronic belching can be a difficult and socially disabling symptom often attributed to reflux with poor response to therapy. In patients where aerophagia is identified as a clear cause, treatment with baclofen may not be tolerated, and biofeedback therapy is time-intensive and may still not be effective. In this pilot study, an office-based easy-to-perform method based on sustained glottal opening was used in five patients with chronic belching, in whom reflux and other causes had been excluded. Treatment consisted of having the patient breathe slowly and diaphragmatically with his or her mouth open during supine, then sitting periods to prevent belching. When this was successful, patients were then counseled on continuing this breathing with mouth slightly ajar as an outpatient using this persistently. Wide mouth opening was used for rescue therapy of belching attacks. All five patients responded to the office-based therapy with complete cessation of belching during the visit. At 1-month follow up, four patients remained asymptomatic. One patient was asymptomatic but for two breakthrough attacks easily managed with the protocol. A simple office-based procedure based on complete glottal opening can be curative for a subset of patients with chronic eructation secondary to repetitive air swallowing.
    背景与目标: :慢性气可能是一种困难且使人无法接受的症状,通常归因于对治疗反应较差的反流。在气吞被确定为明确原因的患者中,用巴氯芬治疗可能不被接受,生物反馈疗法需要大量时间,并且可能仍然无效。在这项前瞻性研究中,对五名慢性气病患者使用了基于办公室的基于持续声门打开的易于执行的方法,其中排除了反流和其他原因。治疗包括在仰卧期间让患者张开嘴缓慢地横diaphragm地呼吸,然后坐下以防止气。成功后,建议患者在门诊坚持不停地继续微呼吸。张开嘴用于rescue气发作的抢救治疗。所有五位患者在就诊期间均对基于办公室的治疗产生了反应,完全停止了气。在1个月的随访中,有4例患者无症状。一名患者无症状,但通过该方案可轻松应对两次突破性发作。一个简单的基于办公室的程序,基于完全的声门打开,可以治愈一部分因反复吞咽而引起的慢性勃起病的患者。
  • 【冠状动脉异常:一种多学科方法来塑造具有挑战性的问题的态势。】 复制标题 收藏 收藏
    DOI:10.1111/chd.12490 复制DOI
    作者列表:Molossi S,Agrawal H
    BACKGROUND & AIMS: :Coronary artery anomalies, particularly anomalous aortic origin of a coronary artery with an interarterial course, are associated with sudden cardiac arrest or death in the young. There is paucity of data on risk stratification and longitudinal follow up is lacking in these patients. Collaboration and sharing of data among specialized centers might shed much needed light in this complex problem.
    背景与目标: :冠状动脉异常,尤其是冠状动脉的主动脉起源于动脉间过程,与年轻的心脏骤停或死亡有关。这些患者的风险分层数据很少,缺乏纵向随访。在这个复杂的问题中,专业中心之间的协作和数据共享可能为我们提供了亟需的信息。

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