Identification of tumour necrosis factor apoptosis inducing ligand (TRAIL), a TNF family ligand, sparked a torrent of research, following an initial observation that it could kill tumour cells, but spare normal cells....Identification of tumour necrosis factor apoptosis inducing ligand (TRAIL), a TNF family ligand, sparked a torrent of research, following an initial observation that it could kill tumour cells, but spare normal cells. Almost a decade after its discovery, and with five known receptors, the true physiological role of TRAIL is still debated and its anti-tumorigenic properties limited by potential toxicity. This review takes a comprehensive look at the story of this enigmatic ligand, addressing its remaining potential as a therapeutic and providing an overview of the TRAIL receptors themselves.展开更多
Aims Grasslands are the world’s most extensive terrestrial ecosystem,and are a major feed source for livestock.Meeting increasing demand for meat and other dairy products in a sustainable manner is a big challenge.At...Aims Grasslands are the world’s most extensive terrestrial ecosystem,and are a major feed source for livestock.Meeting increasing demand for meat and other dairy products in a sustainable manner is a big challenge.At a field scale,Global Positioning System and ground-based sensor technologies provide promising tools for grassland and herd management with high precision.With the growth in availability of spaceborne remote sensing data,it is therefore important to revisit the relevant methods and applications that can exploit this imagery.In this article,we have reviewed the(i)current status of grassland monitoring/observation methods and applications based on satellite remote sensing data,(ii)the technological and methodological developments to retrieve different grassland biophysical parameters and management characteristics(i.e.degradation,grazing intensity)and(iii)identified the key remaining challenges and some new upcoming trends for future development.Important Findings The retrieval of grassland biophysical parameters have evolved in recent years from classical regression analysis to more complex,efficient and robust modeling approaches,driven by satellite data,and are likely to continue to be the most robust method for deriving grassland information,however these require more high quality calibration and validation data.We found that the hypertemporal satellite data are widely used for time series generation,and particularly to overcome cloud contamination issues,but the current low spatial resolution of these instruments precludes their use for field-scale application in many countries.This trend may change with the current rise in launch of satellite constellations,such as RapidEye,Sentinel-2 and even the microsatellites such as those operated by Skybox Imaging.Microwave imagery has not been widely used for grassland applications,and a better understanding of the backscatter behaviour from different phenological stages is needed for more reliable products in cloudy regions.The development of hyperspect展开更多
AIM To assess daclatasvir plus asunaprevir(d UAL) in treatment-na?ve patients from China's Mainland, Russia and South Korea with hepatitis C virus(HCV) genotype 1 b infection. METHODS Patients were randomly assign...AIM To assess daclatasvir plus asunaprevir(d UAL) in treatment-na?ve patients from China's Mainland, Russia and South Korea with hepatitis C virus(HCV) genotype 1 b infection. METHODS Patients were randomly assigned(3:1) to receive 24 wk of treatment with d UAL(daclatasvir 60 mg once daily and asunaprevir 100 mg twice daily) beginning on day 1 of the treatment period(immediate treatment arm) or following 12 wk of matching placebo(placebodeferred treatment arm). The primary endpoint was a comparison of sustained virologic response at posttreatment week 12(SVR12) compared with the historical SVR rate for peg-interferon plus ribavirin(70%) among patients in the immediate treatment arm. The first 12 wk of the study were blinded. Safety was assessed in d UAL-treated patients compared with placebo patients during the first 12 wk(doubleblind phase), and during 24 wk of d UAL in both arms combined.RESULTS In total, 207 patients were randomly assigned to immediate(n = 155) or placebo-deferred(n = 52) treatment. Most patients were Asian(86%), female(59%) and aged < 65 years(90%). Among them, 13% had cirrhosis, 32% had IL28 B non-CC genotypes and 53% had baseline HCV RNA levels of ≥ 6 million IU/m L. Among patients in the immediate treatment arm, SVR12 was achieved by 92%(95% confidence interval: 87.2-96.0), which was significantly higher than the historical comparator rate(70%). SVR12 was largely unaffected by cirrhosis(89%), age ≥ 65 years(92%), male sex(90%), baseline HCV RNA ≥ 6 million(89%) or IL28 B non-CC genotypes(96%), although SVR12 was higher among patients without(96%) than among those with(53%) baseline NS5 A resistanceassociated polymorphisms(at L31 or Y93 H). during the double-blind phase, aminotransferase elevations were more common among placebo recipients than among patients receiving d UAL. during 24 wk of d UAL therapy(combined arms), the most common adverse events(≥ 10%) were elevated alanine aminotransferase and upper respiratory tract infection; emergent grade 3-4 laboratory abnormalities were展开更多
This paper shows that for DEM simulations of triaxial tests using samples with a grading that is repre- sentative of a real soil, the sample size significantly influences the observed material response. Four DEM sampl...This paper shows that for DEM simulations of triaxial tests using samples with a grading that is repre- sentative of a real soil, the sample size significantly influences the observed material response. Four DEM samples with identical initial states were produced： three cylindrical samples bounded by rigid wails and one bounded by a cubical periodic cell, When subjected to triaxial loading, the samples with rigid boundaries were more dilative, stiffer and reached a higher peak stress ratio than the sample enclosed by periodic boundaries. For the rigid-wall samples, dilatancy increased and stiffness decreased with increasing sample size, The periodic sample was effectively homogeneous, The void ratio increased and the contact density decreased close to the rigid walls, This heterogeneity reduced with increasing sample size. The positions of the critical state lines （CSLs） of the overall response in e-log p＇ space were sensitive to the sample size, although no difference was observed between their slopes. The critical states of the interior regions of the rigid-wall-bounded samples approached that of the homogeneous periodic sample with increasing sample size. The ultimate strength of the material at the critical state is independent of sample size.展开更多
Vascular anomalies constitute some of the most difficult diagnostic and therapeutic enigmas that can be encountered in the practice of medicine. The clinical presentations are extremely protean and can range from an a...Vascular anomalies constitute some of the most difficult diagnostic and therapeutic enigmas that can be encountered in the practice of medicine. The clinical presentations are extremely protean and can range from an asymptomatic birthmark to fulminant。展开更多
Early detection of skeletal metastasis is critical for accurate staging and optimal treatment. This paper briefly reviews our current understanding of the biological mechanisms through which tumours metastasise to bon...Early detection of skeletal metastasis is critical for accurate staging and optimal treatment. This paper briefly reviews our current understanding of the biological mechanisms through which tumours metastasise to bone and describes the available imaging methods to diagnose bone metastasis and monitor response to treatment. Among the various imaging modalities currently available for imaging skeletal metastasis, hybrid techniques whichfuse morphological and functional data are the most sensitive and specific, and positron emission tomography(PET)/computed tomography and PET/magnetic resonance imaging will almost certainly continue to evolve and become increasingly important in this regard.展开更多
River managers in Australia are managing in the face of extremes to provide security of water supply for people, production and the environment. Balancing the water requirements of people, environments and econo- mies...River managers in Australia are managing in the face of extremes to provide security of water supply for people, production and the environment. Balancing the water requirements of people, environments and econo- mies requires that water security is viewed holistically, not just in terms of the water available for human consump- tion. Common definitions of water security focus on the needs of both humans and ecosystems for purposes such as drinking, agriculture and industrial use, and to maintain ecological values. Information about achieving water security for the environment or ecological purposes can be a challenge to interpret because the watering require- ments of key ecological processes or assets are not well understood, and the links between ecological and human values are often not obvious to water users. Yet the concepts surrounding river health are inherently linked to holistic concepts of water security. The measurement of aquatic biota provides a valuable tool for managers to understand progress toward achieving ecological water security objectives. This paper provides a comprehensive review of the reference condition approach to river health assessment, using the development of the Australian River Assessment System （AUSRIVAS） as a case study. We make the link between the biological assessment of river health and assessment of ecological water security, and suggest that such an approach provides a way of reporting that is relevant to the contribution made by ecosystems to water security. The reference condition approach, which is the condition representative of minimally disturbed sites organized by selected physical, chemical, and biological characteristics, is most important for assessing ecological water security objectives.展开更多
BACKGROUND The trans-fat containing AMLN(amylin liver non-alcoholic steatohepatitis,NASH)diet has been extensively validated in C57BL/6J mice with or without the Lep^ob/Lep^ob(ob/ob)mutation in the leptin gene for rel...BACKGROUND The trans-fat containing AMLN(amylin liver non-alcoholic steatohepatitis,NASH)diet has been extensively validated in C57BL/6J mice with or without the Lep^ob/Lep^ob(ob/ob)mutation in the leptin gene for reliably inducing metabolic and liver histopathological changes recapitulating hallmarks of NASH.Due to a recent ban on trans-fats as food additive,there is a marked need for developing a new diet capable of promoting a compatible level of disease in ob/ob and C57BL/6J mice.AIM To develop a biopsy-confirmed mouse model of NASH based on an obesogenic diet with trans-fat substituted by saturated fat.METHODS Male ob/ob mice were fed AMLN diet or a modified AMLN diet with trans-fat(Primex shortening)substituted by equivalent amounts of palm oil[Gubra amylin NASH,(GAN)diet]for 8,12 and 16 wk.C57BL/6J mice were fed the same diets for 28 wk.AMLN and GAN diets had similar caloric content(40%fat kcal),fructose(22%)and cholesterol(2%)level.RESULTS The GAN diet was more obesogenic compared to the AMLN diet and impaired glucose tolerance.Biopsy-confirmed steatosis,lobular inflammation,hepatocyte ballooning,fibrotic liver lesions and hepatic transcriptome changes were similar in ob/ob mice fed the GAN or AMLN diet.C57BL/6J mice developed a mild to moderate fibrotic NASH phenotype when fed the same diets.CONCLUSION Substitution of Primex with palm oil promotes a similar phenotype of biopsyconfirmed NASH in ob/ob and C57BL/6J mice,making GAN diet-induced obese mouse models suitable for characterizing novel NASH treatments.展开更多
Background：Pediatric emergency rooms （PERs） in Chinese hospitals are perpetually full of sick and injured children because of the lack of sufficiently developed community hospitals and low access to family physicia...Background：Pediatric emergency rooms （PERs） in Chinese hospitals are perpetually full of sick and injured children because of the lack of sufficiently developed community hospitals and low access to family physicians.The aim of this study was to evaluate the clinical value of a new five-level Chinese pediatric emergency triage system （CPETS）,modeled after the Canadian Triage System and Acuity Scale.Methods：In this study,we compared CPETS outcomes in our PER relative to those of the prior two-level system.Patients who visited our PER before （January 2013-June 2013） and after （January 2014-June 2014） the CPETS was implemented served as the control and experimental group,respectively.Patient flow,triage rates,triage accuracy,wait times （overall and for severe patients）,and patient/family satisfaction were compared between the two groups.Results：Relative to the performance of the former system experienced by the control group,the CPETS experienced by the experimental group was associated with a reduced patient flow through the PER （Cox-Stuart test,t =0,P 〈 0.05）,a higher triage rate （93.40% vs.90.75%;χ^2 =801.546,P 〈 0.001）,better triage accuracy （96.32% vs.85.09%;χ^2 =710.904,P 〈 0.001）,shorter overall wait times （37.30 ± 13.80 min vs.41.60 ± 15.40 min;t =11.27,P 〈 0.001）,markedly shorter wait times for severe patients （2.07 [0.65,4.11] min vs.3.23 [1.90,4.36] min;z =-2.057,P =0.040）,and higher family satisfaction rates （94.23% vs.92.21%;x2 =321.528,P 〈 0.001）.Conclusions：Implementing the CPETS improved nurses＇ abilities to triage severe patients and,thus,to deliver the urgent treatments more quickly.The system shunted nonurgent patients to outpatient care effectively,resulting in improved efficiency of PER health-care delivery.展开更多
AIM：To assess strabismus control and motor ocular alignment for basic exotropia surgery at 5y follow-up.METHODS：The medical records of 80 consecutive patients aged less than 17 years of age,who underwent surgery for...AIM：To assess strabismus control and motor ocular alignment for basic exotropia surgery at 5y follow-up.METHODS：The medical records of 80 consecutive patients aged less than 17 years of age,who underwent surgery for basic exotropia by a single surgeon between years 2000 to 2009 and completed a minimum of 5y follow-up post-operatively were reviewed.Pre- and post-operative characteristics were documented at 1wk,6mo,1,3 and 5y follow-up.Subjects at 5-year follow-up were assigned to the success group if they had a postoperative angle of deviation within 10 prism diopters of exotropia or within 5 prism diopters of esotropia for distance on prism cover test,and had moderate to good strabismus control.The remaining subjects were assigned to the failure group.RESULTS：Post-operative surgical success at one week was 75%,which decreased to 41% at 5y follow-up.The success group was noted to have more patching pre-operatively（P=0.003）.The duration of patching a day（P=0.020） and total duration of patching preoperatively（P=0.030） was higher in the success group.Surgical success at 1y（P=0.004） and 3y（P=0.002） were associated with higher surgical success at 5y follow-up.CONCLUSION：Post-operative motor alignment and strabismus control for basic exotropia surgery at 1y and beyond is associated with higher exotropia surgery success at 5-year follow-up.There is an association between pre-operative patching and 5-year surgical success of basic intermittent exotropia surgery.展开更多
Research Background: Psychological stressors leading to poor mental health outcomes accumulate throughout the migration process. The impact of a parent or caregiver’s posttraumatic stress on non-traumatized children ...Research Background: Psychological stressors leading to poor mental health outcomes accumulate throughout the migration process. The impact of a parent or caregiver’s posttraumatic stress on non-traumatized children is significant and may lead to adverse development and mental health outcomes. Research Objectives: The objective of this review is to explore both the consequences of parental trauma transmission on descendants’ psychological adjustment and well-being, and the mechanisms through which trauma has been transmitted among im/migrant populations. Methods: Criteria outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guided this systemic review. The questions guiding this review are: (a) What are the consequences of parental trauma transmission on the psychological adjustment and well-being of im/migrant offspring? And (b) What are the psychosocial mechanisms of trauma and resilience transmission among im/migrant populations? Each potential study was assessed based on relevance to the review question(s). Results: Parental trauma can lead to adverse mental health outcomes among descendants including increased internalizing and externalizing problems, the adoption of coping behaviors and worldviews, and worsening school performance. Mechanisms that influence trauma transmission include parental trauma symptom severity, the parent-child dyad, social learning, and family stressors. Pathways of resilience exist across socioecological levels to include individual resilience such as coping skills and meaning making, family resilience, structural protective factors, and social and cultural protective factors. Conclusions: Despite the prevalence of traumatic events throughout the migration process, im/migrant families display strong levels of resilience. Mental health services and providers should incorporate a strength-based approach in designing interventions that are culturally responsive and take into accounts the broader ecological contexts in which im/migra展开更多
Introduction: Maternal mortality rates have more than doubled in the U.S over the last two decades, making it one of the few places in the world where maternal mortality is increasing. Differences in maternal mortalit...Introduction: Maternal mortality rates have more than doubled in the U.S over the last two decades, making it one of the few places in the world where maternal mortality is increasing. Differences in maternal mortality among certain races and ethnicities are known but few studies examine maternal mortality among immigrants. Since immigrants represent 13.7% of the U.S. population, it is essential to examine immigrant subsets to understand maternal mortality among this vulnerable population. Methods: A literature search identified 318 articles on maternal mortality and immigrants, with 12 articles from the U.S. The keywords included maternal mortality, United States, migrants, asylum seekers, immigrants, and disparities. Maternal mortality statistics were obtained from the World Health Organization and Center for Disease Control. Results: Studies analyzed in this review found an overall lower maternal mortality rate among immigrant women compared to U.S.-born women, except for Hispanic immigrant women. Black women had the highest maternal mortality rate, regardless of immigration status. Conclusion: Although the literature points to lower maternal mortality among immigrants, the data is still somewhat mixed, making it challenging to draw comprehensive conclusions. Additional research examining maternal mortality among Im/migrants in the U.S. is needed to guide future training among healthcare professionals and policymakers.展开更多
文摘Identification of tumour necrosis factor apoptosis inducing ligand (TRAIL), a TNF family ligand, sparked a torrent of research, following an initial observation that it could kill tumour cells, but spare normal cells. Almost a decade after its discovery, and with five known receptors, the true physiological role of TRAIL is still debated and its anti-tumorigenic properties limited by potential toxicity. This review takes a comprehensive look at the story of this enigmatic ligand, addressing its remaining potential as a therapeutic and providing an overview of the TRAIL receptors themselves.
基金Teagasc Walsh Fellowship Program for funding this research.
文摘Aims Grasslands are the world’s most extensive terrestrial ecosystem,and are a major feed source for livestock.Meeting increasing demand for meat and other dairy products in a sustainable manner is a big challenge.At a field scale,Global Positioning System and ground-based sensor technologies provide promising tools for grassland and herd management with high precision.With the growth in availability of spaceborne remote sensing data,it is therefore important to revisit the relevant methods and applications that can exploit this imagery.In this article,we have reviewed the(i)current status of grassland monitoring/observation methods and applications based on satellite remote sensing data,(ii)the technological and methodological developments to retrieve different grassland biophysical parameters and management characteristics(i.e.degradation,grazing intensity)and(iii)identified the key remaining challenges and some new upcoming trends for future development.Important Findings The retrieval of grassland biophysical parameters have evolved in recent years from classical regression analysis to more complex,efficient and robust modeling approaches,driven by satellite data,and are likely to continue to be the most robust method for deriving grassland information,however these require more high quality calibration and validation data.We found that the hypertemporal satellite data are widely used for time series generation,and particularly to overcome cloud contamination issues,but the current low spatial resolution of these instruments precludes their use for field-scale application in many countries.This trend may change with the current rise in launch of satellite constellations,such as RapidEye,Sentinel-2 and even the microsatellites such as those operated by Skybox Imaging.Microwave imagery has not been widely used for grassland applications,and a better understanding of the backscatter behaviour from different phenological stages is needed for more reliable products in cloudy regions.The development of hyperspect
文摘AIM To assess daclatasvir plus asunaprevir(d UAL) in treatment-na?ve patients from China's Mainland, Russia and South Korea with hepatitis C virus(HCV) genotype 1 b infection. METHODS Patients were randomly assigned(3:1) to receive 24 wk of treatment with d UAL(daclatasvir 60 mg once daily and asunaprevir 100 mg twice daily) beginning on day 1 of the treatment period(immediate treatment arm) or following 12 wk of matching placebo(placebodeferred treatment arm). The primary endpoint was a comparison of sustained virologic response at posttreatment week 12(SVR12) compared with the historical SVR rate for peg-interferon plus ribavirin(70%) among patients in the immediate treatment arm. The first 12 wk of the study were blinded. Safety was assessed in d UAL-treated patients compared with placebo patients during the first 12 wk(doubleblind phase), and during 24 wk of d UAL in both arms combined.RESULTS In total, 207 patients were randomly assigned to immediate(n = 155) or placebo-deferred(n = 52) treatment. Most patients were Asian(86%), female(59%) and aged < 65 years(90%). Among them, 13% had cirrhosis, 32% had IL28 B non-CC genotypes and 53% had baseline HCV RNA levels of ≥ 6 million IU/m L. Among patients in the immediate treatment arm, SVR12 was achieved by 92%(95% confidence interval: 87.2-96.0), which was significantly higher than the historical comparator rate(70%). SVR12 was largely unaffected by cirrhosis(89%), age ≥ 65 years(92%), male sex(90%), baseline HCV RNA ≥ 6 million(89%) or IL28 B non-CC genotypes(96%), although SVR12 was higher among patients without(96%) than among those with(53%) baseline NS5 A resistanceassociated polymorphisms(at L31 or Y93 H). during the double-blind phase, aminotransferase elevations were more common among placebo recipients than among patients receiving d UAL. during 24 wk of d UAL therapy(combined arms), the most common adverse events(≥ 10%) were elevated alanine aminotransferase and upper respiratory tract infection; emergent grade 3-4 laboratory abnormalities were
基金funding from the Royal Commission for the Exhibition of 1851provided as part of grant EP/1006761/1 from the Engineering and Physical Sciences Research Council
文摘This paper shows that for DEM simulations of triaxial tests using samples with a grading that is repre- sentative of a real soil, the sample size significantly influences the observed material response. Four DEM samples with identical initial states were produced： three cylindrical samples bounded by rigid wails and one bounded by a cubical periodic cell, When subjected to triaxial loading, the samples with rigid boundaries were more dilative, stiffer and reached a higher peak stress ratio than the sample enclosed by periodic boundaries. For the rigid-wall samples, dilatancy increased and stiffness decreased with increasing sample size, The periodic sample was effectively homogeneous, The void ratio increased and the contact density decreased close to the rigid walls, This heterogeneity reduced with increasing sample size. The positions of the critical state lines （CSLs） of the overall response in e-log p＇ space were sensitive to the sample size, although no difference was observed between their slopes. The critical states of the interior regions of the rigid-wall-bounded samples approached that of the homogeneous periodic sample with increasing sample size. The ultimate strength of the material at the critical state is independent of sample size.
文摘Vascular anomalies constitute some of the most difficult diagnostic and therapeutic enigmas that can be encountered in the practice of medicine. The clinical presentations are extremely protean and can range from an asymptomatic birthmark to fulminant。
文摘Early detection of skeletal metastasis is critical for accurate staging and optimal treatment. This paper briefly reviews our current understanding of the biological mechanisms through which tumours metastasise to bone and describes the available imaging methods to diagnose bone metastasis and monitor response to treatment. Among the various imaging modalities currently available for imaging skeletal metastasis, hybrid techniques whichfuse morphological and functional data are the most sensitive and specific, and positron emission tomography(PET)/computed tomography and PET/magnetic resonance imaging will almost certainly continue to evolve and become increasingly important in this regard.
文摘River managers in Australia are managing in the face of extremes to provide security of water supply for people, production and the environment. Balancing the water requirements of people, environments and econo- mies requires that water security is viewed holistically, not just in terms of the water available for human consump- tion. Common definitions of water security focus on the needs of both humans and ecosystems for purposes such as drinking, agriculture and industrial use, and to maintain ecological values. Information about achieving water security for the environment or ecological purposes can be a challenge to interpret because the watering require- ments of key ecological processes or assets are not well understood, and the links between ecological and human values are often not obvious to water users. Yet the concepts surrounding river health are inherently linked to holistic concepts of water security. The measurement of aquatic biota provides a valuable tool for managers to understand progress toward achieving ecological water security objectives. This paper provides a comprehensive review of the reference condition approach to river health assessment, using the development of the Australian River Assessment System （AUSRIVAS） as a case study. We make the link between the biological assessment of river health and assessment of ecological water security, and suggest that such an approach provides a way of reporting that is relevant to the contribution made by ecosystems to water security. The reference condition approach, which is the condition representative of minimally disturbed sites organized by selected physical, chemical, and biological characteristics, is most important for assessing ecological water security objectives.
基金Supported by the Innovation Fund Denmark,Tolbol KS,No.5016-00168B
文摘BACKGROUND The trans-fat containing AMLN(amylin liver non-alcoholic steatohepatitis,NASH)diet has been extensively validated in C57BL/6J mice with or without the Lep^ob/Lep^ob(ob/ob)mutation in the leptin gene for reliably inducing metabolic and liver histopathological changes recapitulating hallmarks of NASH.Due to a recent ban on trans-fats as food additive,there is a marked need for developing a new diet capable of promoting a compatible level of disease in ob/ob and C57BL/6J mice.AIM To develop a biopsy-confirmed mouse model of NASH based on an obesogenic diet with trans-fat substituted by saturated fat.METHODS Male ob/ob mice were fed AMLN diet or a modified AMLN diet with trans-fat(Primex shortening)substituted by equivalent amounts of palm oil[Gubra amylin NASH,(GAN)diet]for 8,12 and 16 wk.C57BL/6J mice were fed the same diets for 28 wk.AMLN and GAN diets had similar caloric content(40%fat kcal),fructose(22%)and cholesterol(2%)level.RESULTS The GAN diet was more obesogenic compared to the AMLN diet and impaired glucose tolerance.Biopsy-confirmed steatosis,lobular inflammation,hepatocyte ballooning,fibrotic liver lesions and hepatic transcriptome changes were similar in ob/ob mice fed the GAN or AMLN diet.C57BL/6J mice developed a mild to moderate fibrotic NASH phenotype when fed the same diets.CONCLUSION Substitution of Primex with palm oil promotes a similar phenotype of biopsyconfirmed NASH in ob/ob and C57BL/6J mice,making GAN diet-induced obese mouse models suitable for characterizing novel NASH treatments.
文摘Background：Pediatric emergency rooms （PERs） in Chinese hospitals are perpetually full of sick and injured children because of the lack of sufficiently developed community hospitals and low access to family physicians.The aim of this study was to evaluate the clinical value of a new five-level Chinese pediatric emergency triage system （CPETS）,modeled after the Canadian Triage System and Acuity Scale.Methods：In this study,we compared CPETS outcomes in our PER relative to those of the prior two-level system.Patients who visited our PER before （January 2013-June 2013） and after （January 2014-June 2014） the CPETS was implemented served as the control and experimental group,respectively.Patient flow,triage rates,triage accuracy,wait times （overall and for severe patients）,and patient/family satisfaction were compared between the two groups.Results：Relative to the performance of the former system experienced by the control group,the CPETS experienced by the experimental group was associated with a reduced patient flow through the PER （Cox-Stuart test,t =0,P 〈 0.05）,a higher triage rate （93.40% vs.90.75%;χ^2 =801.546,P 〈 0.001）,better triage accuracy （96.32% vs.85.09%;χ^2 =710.904,P 〈 0.001）,shorter overall wait times （37.30 ± 13.80 min vs.41.60 ± 15.40 min;t =11.27,P 〈 0.001）,markedly shorter wait times for severe patients （2.07 [0.65,4.11] min vs.3.23 [1.90,4.36] min;z =-2.057,P =0.040）,and higher family satisfaction rates （94.23% vs.92.21%;x2 =321.528,P 〈 0.001）.Conclusions：Implementing the CPETS improved nurses＇ abilities to triage severe patients and,thus,to deliver the urgent treatments more quickly.The system shunted nonurgent patients to outpatient care effectively,resulting in improved efficiency of PER health-care delivery.
文摘AIM：To assess strabismus control and motor ocular alignment for basic exotropia surgery at 5y follow-up.METHODS：The medical records of 80 consecutive patients aged less than 17 years of age,who underwent surgery for basic exotropia by a single surgeon between years 2000 to 2009 and completed a minimum of 5y follow-up post-operatively were reviewed.Pre- and post-operative characteristics were documented at 1wk,6mo,1,3 and 5y follow-up.Subjects at 5-year follow-up were assigned to the success group if they had a postoperative angle of deviation within 10 prism diopters of exotropia or within 5 prism diopters of esotropia for distance on prism cover test,and had moderate to good strabismus control.The remaining subjects were assigned to the failure group.RESULTS：Post-operative surgical success at one week was 75%,which decreased to 41% at 5y follow-up.The success group was noted to have more patching pre-operatively（P=0.003）.The duration of patching a day（P=0.020） and total duration of patching preoperatively（P=0.030） was higher in the success group.Surgical success at 1y（P=0.004） and 3y（P=0.002） were associated with higher surgical success at 5y follow-up.CONCLUSION：Post-operative motor alignment and strabismus control for basic exotropia surgery at 1y and beyond is associated with higher exotropia surgery success at 5-year follow-up.There is an association between pre-operative patching and 5-year surgical success of basic intermittent exotropia surgery.
文摘Research Background: Psychological stressors leading to poor mental health outcomes accumulate throughout the migration process. The impact of a parent or caregiver’s posttraumatic stress on non-traumatized children is significant and may lead to adverse development and mental health outcomes. Research Objectives: The objective of this review is to explore both the consequences of parental trauma transmission on descendants’ psychological adjustment and well-being, and the mechanisms through which trauma has been transmitted among im/migrant populations. Methods: Criteria outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guided this systemic review. The questions guiding this review are: (a) What are the consequences of parental trauma transmission on the psychological adjustment and well-being of im/migrant offspring? And (b) What are the psychosocial mechanisms of trauma and resilience transmission among im/migrant populations? Each potential study was assessed based on relevance to the review question(s). Results: Parental trauma can lead to adverse mental health outcomes among descendants including increased internalizing and externalizing problems, the adoption of coping behaviors and worldviews, and worsening school performance. Mechanisms that influence trauma transmission include parental trauma symptom severity, the parent-child dyad, social learning, and family stressors. Pathways of resilience exist across socioecological levels to include individual resilience such as coping skills and meaning making, family resilience, structural protective factors, and social and cultural protective factors. Conclusions: Despite the prevalence of traumatic events throughout the migration process, im/migrant families display strong levels of resilience. Mental health services and providers should incorporate a strength-based approach in designing interventions that are culturally responsive and take into accounts the broader ecological contexts in which im/migra
文摘Introduction: Maternal mortality rates have more than doubled in the U.S over the last two decades, making it one of the few places in the world where maternal mortality is increasing. Differences in maternal mortality among certain races and ethnicities are known but few studies examine maternal mortality among immigrants. Since immigrants represent 13.7% of the U.S. population, it is essential to examine immigrant subsets to understand maternal mortality among this vulnerable population. Methods: A literature search identified 318 articles on maternal mortality and immigrants, with 12 articles from the U.S. The keywords included maternal mortality, United States, migrants, asylum seekers, immigrants, and disparities. Maternal mortality statistics were obtained from the World Health Organization and Center for Disease Control. Results: Studies analyzed in this review found an overall lower maternal mortality rate among immigrant women compared to U.S.-born women, except for Hispanic immigrant women. Black women had the highest maternal mortality rate, regardless of immigration status. Conclusion: Although the literature points to lower maternal mortality among immigrants, the data is still somewhat mixed, making it challenging to draw comprehensive conclusions. Additional research examining maternal mortality among Im/migrants in the U.S. is needed to guide future training among healthcare professionals and policymakers.
