秋,孙学涛,谢余强,杜祝

牧中心!浙江义乌322000 @陈芳$义乌市畜牧中心!浙江义乌322000规划与设计:8525,分娩舍:2372,污水处理:2209,生产区:1904,浙江义乌:1766,保育舍:1718,公猪舍:1485,规划设计:1425,义乌市:1327,场址选择:1048规划与设计:5357,猪舍:4995,分娩舍:3526,生产区:2830,保育舍:2555,转     

端视ICP—AES法测定尿中Pb,Mn,Cd,As,Se,Cr,Be,Ni,Cu,Zn等微量元素

尿中Ｐｂ、Ｍｎ、Ｃｄ、Ａｓ、Ｓｅ、Ｃｒ、Ｂｅ、Ｎｉ、Ｃｕ、Ｚｎ等微量元素是反应职业接触水平的重要指标,其准确测定为职业病防治、急慢性中毒诊断等提供科学依据。已建立的方法有化学比色法〔２〕、原子吸收法〔２、７、１１〕、示波极谱法〔２〕、荧光分光光度法〔２〕、气相色谱法〔２〕、阳极溶出伏安法〔２〕等,但这些方法大部分具有操作复杂、灵敏度低、消耗试剂多、分析周期长、可能接触有毒有害试剂等缺点。ＩＣＰ－ＡＥＳ法测定尿中多种元素,国内外文献已有报道〔１、３－６、８－１０、１２〕。但传统的ＩＣＰ－ＡＥＳ法检…     

Alt, krank, arbeitslos, chancenlos?

Illness can be the cause and consequence of unemployment. These relationships are well documented but only few data on the effectiveness of interventions are available. The study examines the effectiveness of a combined health and employment promotion intervention (AmigA - currently projected in several sites in Germany) for the older long-term unemployed with the main goals of an improvement of health and integrability as well as sustainable reintegration into the labour market. The evaluation design is a randomised controlled trial with a multi-method approach. A total of 71 participants could be included in the evaluation. Initial results confirm earlier findings on health and unemployment and show a psychologically and physically highly burdened sample. The intervention tended to improve depression, self-efficacy and quality of life. No effects were found for physical health, integrability and sustainable reintegration. It is discussed whether a longer duration and a higher intensity of the intervention might produce better results. The necessity of help and interventions for this highly burdened group of persons is evident but further studies are necessary to decide if the evaluated intervention is adequate to reach the goals of health and employment promotion as a standard measure.     

"From the heart of my bottom": negotiating humor in focus group discussions

Reporting and analyzing interactional data collected during focus groups can be a significant challenge for qualitative health researchers. In this article, the authors explore the use of humor among focus group participants as one area of interaction and negotiation that is methodologically interesting and theoretically insightful. They explore discussions about service user involvement in medical education across eight focus groups consisting of medical educators, medical students, and service users. The findings suggest that humor can be used among focus group participants to maintain solidarity, navigate coping strategies, and negotiate power. Not only is humor useful when exploring new concepts, it can also be an indication of wider views that might not be explicit in an analysis of focus group members' comments alone. The authors urge qualitative health researchers to examine interactions among focus group participants, and their analysis of humor illustrates how this can be achieved.     

‘They don’t know much about us’: educational reform impacts on students’ learning in the clinical environment

Placements are an integral component of the medical, nursing, and allied health curriculum. Literature on problem-based learning indicates that curriculum change can impact student experience. However, outside of the nursing literature, there is little research on the impact of education reform on students’ experiences of placements. This paper reports on medical, midwifery and paramedic students’ perception of the impact of education reform they experienced in the clinical setting. A qualitative study using a semi-structured schedule was conducted. Data was collected using focus groups (17), individual interviews (48) and written responses (2) from undergraduate students (103) and graduates (27) from a tertiary institution in Victoria, Australia. Recorded interviews were analysed, coded and categorised into themes. Whilst students indicated they were prepared for the impact of educational reform on their placement experience, they perceived that clinical educators responsible for teaching them were less prepared. Three themes were identified from the data: clinical educator’s lack of familiarity with new curriculum, clinical educator’s negative attitudes to curricular change and looking to the future. Our study advances the understanding of the implications of education reform during the clinical placement of medical, midwifery, and paramedic students. Whilst important lessons can be learned from the medical and nursing literature this study highlights that staff responsible for curriculum change need to action change management process to ensure that the clinical educators are able to deliver the revised program.     

Learning from lives together: medical and social work students’ experiences of learning from people with disabilities in the community

The study aims to evaluate an interprofessional community‐based learning event, focussing on disability. The learning opportunity was based on the Leicester Model of Interprofessional Education, organised around the experiences and perceptions of service users and their carers. Programme participants were drawn from medicine and social work education in Leicester, UK, bringing together diverse traditions in the care of people with disabilities. Small student groups (3–4 students) worked from one of the eight community rehabilitation hospitals through a programme of contact with people with disabilities in hospital, at home or in other community settings. The evaluation, in March 2005, used a mixed methods approach, incorporating questionnaire surveys, focus group interviews with students and feedback from service users. Responses were collated and analysed using quantitative and qualitative measures. Fifty social work and 100 medical students completed the first combined delivery of the module. The findings indicated that the merging of social work and medical perspectives appear to create some tensions, although overall the student experience was found to be beneficial. Service users (16 responses) valued the process. They were not concerned at the prospect of meeting a number of students at home or elsewhere and were pleased to think of themselves as educators. Problems and obstacles still anticipated include changing the mindset of clinicians and practising social workers to enable them to support students from each other’s disciplines in practice learning. The generally positive outcomes highlight that disability focussed joint learning offers a meaningful platform for interprofessional education in a practice environment.     

Service user involvement in cancer care: the impact on service users

Background Service user involvement is embedded in the United Kingdom’s National Health Service, but knowledge about the impact of involvement on service users, such as the benefits and challenges of involvement, is scant. Our research addresses this gap. Objective To explore the personal impact of involvement on the lives of service users affected by cancer. Design We conducted eight focus groups with user groups supplemented by nine face‐to‐face interviews with involved individuals active at a local, regional and national level. Thematic analysis was conducted both independently and collectively. Setting and participants Sixty‐four participants, engaged in involvement activities in cancer services, palliative care and research, were recruited across Great Britain. Results We identified three main themes: (i) ‘Expectations and motivations for involvement’– the desire to improve services and the need for user groups to have a clear purpose, (ii) ‘Positive aspects of involvement’– support provided by user groups and assistance to live well with cancer and (iii) ‘Challenging aspects of involvement’– insensitivities and undervaluing of involvement by staff. Conclusions This study identified that involvement has the capacity to produce varied and significant personal impacts for involved people. Involvement can be planned and implemented in ways that increase these impacts and that mediates challenges for those involved. Key aspects to increase positive impact for service users include the value service providers attach to involvement activities, the centrality with which involvement is embedded in providers’ activities, and the capacity of involvement to influence policy, planning, service delivery, research and/or practice.     

The impact of service user involvement in research

PURPOSE: There are many examples of consumer involvement in NHS research but few studies have examined the impact of this on service development or the research process. This study, involving service user and carer researchers working alongside professional researchers, aimed to examine the development of one service user and carer research group in a mental health Trust. DERSIGN/METHODOLOGY/APPROACH: The research involved a review of existing literature on consumer involvement in research, a review of user involvement in research in South West Yorkshire Mental Health NHS Trust, a survey of consumers and NHS staff in the Trust, and a skills audit and training needs analysis of consumers. FINDINGS: The study identified the range and extent of consumer involvement and the impact of this on consumers and the Trust. Service users and carers were involved in a range of projects, mainly on the level of consultation or collaboration. The benefits for consumers were principally on a personal level and included gaining knowledge and experience, improved sense of well-being, self esteem, and confidence. The benefit for the Trust was in having a service user perspective and focus. However, there is a tendency to omit service users from planning and setting priorities. PRACTICAL IMPLICATIONS: The study pointed to the need to build the evidence base on consumer involvement in research, particularly in terms of how consumers can impact on setting research priorities and selecting appropriate methods. It identifies the need for more training for consumers and for NHS staff and for a more coherent strategy. ORIGINALITY/VALUE: This article will be of value to anyone who is at the start or in the early stages of their journey of consumer involvement. It identifies some of the practical issues faced by consumers and staff in working collaboratively, but also points to the benefits for all the stakeholders.     

Service Learning in an Occupation-Based Curriculum: Student Commentary

Recent trends toward occupation-based practice and the move toward masters-level occupational therapy (OT) education has forced OT educators to reevaluate their programs to meet the needs of the contemporary health care environment. Service learning is one way to bridge the gap between theory and practice. The Master of Occupational Therapy (MOT) Program at Cleveland State University (CSU), in keeping with its focus on occupation, incorporates three service-learning components into its curriculum. This paper, written by a second-year MOT student at CSU, discusses two of these experiences in depth. The first, which took place at a homeless shelter, included both a didactic and “clinical” component, with an emphasis on community-based mental health OT services. The second, which included a training component and a structured program, involved co-leading after-school social-emotional learning groups for low-income urban youth. Both experiences served to expand the clinical skills and reasoning of the MOT students while introducing both the students and agencies to the role of OT in non-traditional community settings. Based on these experiences, the author highly recommends that all masters-level OT programs should, if they have not done so already, institute service learning as a core component of their curricula, in order to prepare their students for contemporary OT practice.     

Close to the bench as well as at the bedside: involving service users in all phases of translational research

Aim The paper aims to develop a model of translational research in which service user and other stakeholder involvement are central to each phase. Background ‘Translational’ is the current medical buzzword: translational research has been termed ‘bench to bedside’ research and promises to fast‐track biomedical advances in the service of patient benefit. Models usually conceive of translational research as a ‘pipeline’ that is divided into phases: the early phase is characterized as the province of basic scientists and laboratory‐based clinical researchers; the later phases focus on the implementation, dissemination and diffusion of health applications. If service user involvement is mentioned, it is usually restricted to these later phases. Methods The paper critically reviews existing literature on translational research and medicine. The authors develop a theoretical argument that addresses why a reconceptualization of translational research is required on scientific, ethical and pragmatic grounds. Results The authors reconceptualize the model of translational research as an interlocking loop rather than as a pipeline, one in which service user and other stakeholder involvement feed into each of its elements. The authors demonstrate that for the ‘interlocking loop’ model of translational research to be materialized in practice will require changes in how health research is structured and organized. Conclusion The authors demonstrate the scientific, ethical and pragmatic benefits of involving service users in every phase of translational research. The authors’ reconceptualized model of translational research contributes to theoretical and policy debates regarding both translational research and service user involvement.     

User involvement in the development of a research bid: barriers, enablers and impacts.

OBJECTIVE: To involve users in the development of a research bid to examine parents' experiences of having a pre-term baby, and to examine the barriers, enablers and impacts of user involvement. DESIGN: A mainly collaborative approach to user involvement was adopted, although different types of involvement were evident at different stages of the project. Users' experiences and perspectives provided the focus for the regular meetings which underpinned the writing of the research bid. The researcher acted as a facilitator in the development of the bid, with input from users and the wider advisory group. MAIN OUTCOMES: User involvement had an important impact on the development of the research aims, methods and on ethical aspects. Through careful collaboration a research bid was produced which was rooted in users' experiences, whilst also addressing key research questions. Key enablers for involvement included good working relationships, funding for the lead researchers time. Barriers included lack of financial support for users, the time-consuming nature of involvement and the language of research. CONCLUSIONS: If user involvement remains an international policy imperative with little if any support at the vital stage of bid development, policy-makers, service user organizations, researchers, health service providers and commissioners will need to recognize the limited nature of involvement that may result and the impact this would have on the evidence base. Researchers will need to recognize the resource implications of involvement at this point, and user groups will need to decide whether to participate when there is the greatest chance of influencing research but little or no funding.